| NPI | 1114091600 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL A BOATWRIGHT President 843-248-2705 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: SC 2775) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2020-08-22 |