| NPI | 1083983118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETH LOUISE ILLSLEY Director Of Insurance 864-282-1935 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 4138) |
| Enumeration Date | 2011-12-19 |
| Last Update Date | 2023-01-09 |