| NPI | 1124320353 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARGIE CERVANTES Office Manager 803-648-0056 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: SC 4058) |
| Enumeration Date | 2010-11-19 |
| Last Update Date | 2012-02-01 |