Healthcare Provider Details

I. General information

NPI: 1548194285
Provider Name (Legal Business Name): LITTLE MOUNTAIN DENTAL, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 N MILL ST
LITTLE MOUNTAIN SC
29075-8788
US

IV. Provider business mailing address

47 N MILL ST
LITTLE MOUNTAIN SC
29075-8788
US

V. Phone/Fax

Practice location:
  • Phone: 803-816-0027
  • Fax:
Mailing address:
  • Phone: 803-816-0027
  • Fax:

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: DR. MICHAEL CHASE CAPPELLUCCI
Title or Position: DOCTOR/OWNER
Credential: DMD
Phone: 803-816-0027