| NPI | 1114396629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW RYAN MASTROROCCO Dentist 843-682-4601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: SC 3732) |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2015-09-15 |