Provider Demographics
NPI:1518605336
Name:TWIN FALLS ORTHODONTICS LLC
Entity Type:Organization
Organization Name:TWIN FALLS ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-896-7940
Mailing Address - Street 1:2430 HUDSON RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-2923
Mailing Address - Country:US
Mailing Address - Phone:864-896-7940
Mailing Address - Fax:864-896-7941
Practice Address - Street 1:2430 HUDSON RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-2923
Practice Address - Country:US
Practice Address - Phone:864-896-7940
Practice Address - Fax:864-896-7941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental