| NPI | 1043405004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN JOSEPH Office Manager 843-546-5994 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 2114) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 3376) |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2007-09-12 |