Healthcare Provider Details

I. General information

NPI: 1609821123
Provider Name (Legal Business Name): AUNCHANA TOCHAROEN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 SQUIRES POINTE
DUNCAN SC
29334
US

IV. Provider business mailing address

505 SQUIRES POINTE
DUNCAN SC
29334
US

V. Phone/Fax

Practice location:
  • Phone: 864-433-6888
  • Fax: 864-433-6889
Mailing address:
  • Phone: 864-433-6888
  • Fax: 864-433-6889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3620
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: