| NPI | 1124118088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLYDE STOCKTON President 803-735-9446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 1967) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 3901) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2008-06-02 |