| NPI | 1073967303 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HIEU NGOC PHAN Dentist 803-397-9115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC DGD.8561 GD) |
| Enumeration Date | 2016-04-23 |
| Last Update Date | 2016-04-23 |