Provider Demographics
NPI:1235495664
Name:BRANCHAL, CAROLINE FERRELL (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:FERRELL
Last Name:BRANCHAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 ROSLYN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-2932
Mailing Address - Country:US
Mailing Address - Phone:843-259-9622
Mailing Address - Fax:
Practice Address - Street 1:7432 BROAD RIVER ROAD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063
Practice Address - Country:US
Practice Address - Phone:803-781-2511
Practice Address - Fax:803-781-8401
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8156122300000X
390200000X
SC8421223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC86-1616356Medicaid