| NPI | 1073647889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIS ELY HAWKINS Owner 864-855-2788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 3264) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2020-08-22 |