| NPI | 1124296470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL STEPHEN BRANDON Owner 843-769-7759 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 4281) |
| Enumeration Date | 2008-02-20 |
| Last Update Date | 2008-02-20 |