| NPI | 1063689586 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG WILLIAM JACKSON Dentist 843-689-5500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 3926) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2008-05-14 |