| NPI | 1003034026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY JOHNSON President 864-888-0020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 3056) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-08-22 |