| NPI | 1053376491 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA TORLAY - KURSH Financial COO Rdinator 843-216-5879 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: SC 2085) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: SC 3030) |
| 207L00000X Anesthesiology (Licence: SC 7171) | |
| 1223P0221X Dentist Pediatric Dentistry (Licence: SC 3881) | |
| 1223P0221X Dentist Pediatric Dentistry (Licence: SC 3863) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2024-08-01 |