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General NPI Number Information
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NPI Number | 1326625591
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Entity Type | Organization
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Legal Business Name | TINY TEETH
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Dates
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Enumeration Date | 03/25/2021
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 7432 BROAD RIVER ROAD
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City | IRMO
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State | SC
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Zip | 29063
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Country | US
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Telephone | 803-781-2511
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Fax | 803-781-8401
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Provider Business Mailing Address
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Address Line | 7432 BROAD RIVER ROAD
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City | IRMO
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State | SC
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Zip | 29063
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Country | US
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Telephone | 803-781-2511
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Fax | 803-781-8401
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Authorized Official
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Title or Position | OWNER/DENTISH
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Name | DR. CAROLINE FERRELL BRANCHAL
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Credential | DMD
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Telephone | 803-781-2511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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