MEDICARE: TWIN FALLS FAMILY DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8164	SC

General Provider Information

NPI Number	:	1679976740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWIN FALLS FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	2430 HUDSON RD
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29650-2923
Country	:	US
Telephone Number	:	864-896-7940
Fax Number	:

Provider Business Practice Location Address
First Line	:	2430 HUDSON RD
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29650-2923
Country	:	US
Telephone Number	:	864-896-7940
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. PETER A. MCPHERSON
Credential	:	DMD
Telephone Number	:	864-896-7940

Provider Enumeration Date	:	10/03/2014
Last Update Date	:	10/03/2014

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Directions to “TWIN FALLS FAMILY DENTISTRY ” Practice Location

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