| NPI | 1033238589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA BODIFORD Office Manager 843-797-5133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: SC 2638-0358 SC) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2020-08-22 |