| 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 |