| NPI | 1033341433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA RAY BACKMAN Dentist 803-359-3245 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: SC 4290) |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2009-08-18 |