Healthcare Provider Details

I. General information

NPI: 1235495664
Provider Name (Legal Business Name): CAROLINE FERRELL BRANCHAL D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 08/25/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7432 BROAD RIVER ROAD
IRMO SC
29063
US

IV. Provider business mailing address

1719 ROSLYN DR
COLUMBIA SC
29206-2932
US

V. Phone/Fax

Practice location:
  • Phone: 803-781-2511
  • Fax: 803-781-8401
Mailing address:
  • Phone: 843-259-9622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8156
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number842
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: