Provider Demographics
NPI:1972626224
Name:PLAYER, TOMMY CARROLL (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:CARROLL
Last Name:PLAYER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 W PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4302
Mailing Address - Country:US
Mailing Address - Phone:843-669-5687
Mailing Address - Fax:843-669-0161
Practice Address - Street 1:614 W PALMETTO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4302
Practice Address - Country:US
Practice Address - Phone:843-669-5687
Practice Address - Fax:843-669-0161
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC12421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ-12424Medicaid