NPI | 1124245626 |
---|---|
Entity Type | Organization |
Authorized Contact | JERRY W. CROCKETT Business Manager 864-234-9800 |
Organization Subpart ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC sc3486) |
Enumeration Date | 2007-04-19 |
Last Update Date | 2020-08-22 |