Healthcare Provider Details

I. General information

NPI: 1538516042
Provider Name (Legal Business Name): RIVER FALLS PEDITRIC DENTISTRY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 SQUIRES PT
DUNCAN SC
29334-8867
US

IV. Provider business mailing address

505 SQUIRES PT
DUNCAN SC
29334-8867
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 Code261QD0000X
TaxonomyDental Clinic/Center
License Number3620
License Number StateSC

VIII. Authorized Official

Name: DR. AUNCHANA TOCHAROEN
Title or Position: OWNER
Credential: DMD
Phone: 864-433-6888