| NPI | 1083125264 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED ROBERT BURR Owner 864-277-1603 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: SC 8728) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 2021) |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2017-10-17 |