Provider Demographics
NPI:1326625591
Name:TINY TEETH
Entity Type:Organization
Organization Name:TINY TEETH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTISH
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:FERRELL
Authorized Official - Last Name:BRANCHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-781-2511
Mailing Address - Street 1:7432 BROAD RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063
Mailing Address - Country:US
Mailing Address - Phone:803-781-2511
Mailing Address - Fax:803-781-8401
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty