| Organization Name: | DUTCH FORK FAMILY DENTISTRY, PA |
| NPI Number: | 1104166792 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHERRY BENENHALEY RAUCH (PRESIDENT) |
| Mailing Address: | 7436 Broad River Rd Ste 111 Irmo |
| State: | SC US |
| Postal Code: | 290637601 |
| Phone Number: | 8037493333 |
| Fax Number: | 8037493335 |
| NPI Enumeration Date: | 02/19/2013 |
| NPI Last Update Date: | 02/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 4654 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |