| NPI | 1043699770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETH ILLSLEY Director Of Insurance 864-282-1935 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: SC 7146/788) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2023-01-18 |