Provider Demographics
NPI:1144762576
Name:SFD CARNES LLC
Entity type:Organization
Organization Name:SFD CARNES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAZZLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-871-0842
Mailing Address - Street 1:1971 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7820
Mailing Address - Country:US
Mailing Address - Phone:843-871-0842
Mailing Address - Fax:
Practice Address - Street 1:110 PARISH FARMS DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-0409
Practice Address - Country:US
Practice Address - Phone:843-300-1635
Practice Address - Fax:843-300-1639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33521223G0001X
SC80911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ33526Medicaid
SCZX8091Medicaid