| Organization Name: | KIDS TEETH, LLC |
| NPI Number: | 1053376491 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BELINDA R WIERSCHEM (OFFICE MANAGER) |
| Mailing Address: | 389 Johnnie Dodds Blvd Suite B Mt Pleasant |
| State: | SC US |
| Postal Code: | 294642950 |
| Phone Number: | 8438847041 |
| Fax Number: | 8439719299 |
| NPI Enumeration Date: | 04/19/2006 |
| NPI Last Update Date: | 01/25/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0221X |
| License Number: | 3881 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | SC |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Pediatric Dentistry |
| Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |