| NPI | 1073068847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW WAYNE COOK Ower/Doctor 803-637-4616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: SC 4708) |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2021-06-23 |