| NPI | 1093904955 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA T. VU-HEATON Dentist 803-783-1198 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 3751) |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2008-08-26 |