| NPI | 1023151552 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES TIMOTHY ASSEY Owner 843-884-6004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 2472) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2012-11-21 |