Healthcare Provider Details

I. General information

NPI: 1457212383
Provider Name (Legal Business Name): TWIN FALLS FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 HUDSON RD
GREER SC
29650-2923
US

IV. Provider business mailing address

2430 HUDSON RD
GREER SC
29650-2923
US

V. Phone/Fax

Practice location:
  • Phone: 864-896-7940
  • Fax: 864-896-7941
Mailing address:
  • Phone: 864-896-7940
  • Fax: 864-896-7941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CINDY COOPER
Title or Position: OFFICE MANAGER
Credential:
Phone: 864-896-7940