Provider Demographics
NPI:1396981304
Name:CARNES CROSSROADS DENTAL ARTS P.A.
Entity type:Organization
Organization Name:CARNES CROSSROADS DENTAL ARTS P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-761-8370
Mailing Address - Street 1:3751 S LIVE OAK DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-8746
Mailing Address - Country:US
Mailing Address - Phone:843-761-7380
Mailing Address - Fax:843-761-7385
Practice Address - Street 1:3751 S LIVE OAK DR
Practice Address - Street 2:SUITE G
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-8746
Practice Address - Country:US
Practice Address - Phone:843-761-7380
Practice Address - Fax:843-761-7385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC4275261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental