| NPI | 1053471623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AVANGELA KAY CRISWELL Business Office Director 843-663-8017 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 4406) |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2012-11-02 |