| NPI | 1033986096 |
|---|---|
| Former Legal Business Name | PRIME PEDIATRIC DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | KATHY BOURGOYNE Office Manager 843-536-9888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2023-12-08 |
| Last Update Date | 2023-12-08 |