| NPI | 1114677077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY JOHNSON Owner 843-884-8884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2022-03-24 |