| NPI | 1033532262 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT F. GARRISON Owner 803-661-8468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 30-2494) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: SC 4641765) |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2014-01-23 |