| NPI | 1114184439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STAFFORD DALE TANNER Dentist 843-884-5166 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 2601) |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2008-05-22 |