| NPI | 1124332465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM FREDRICK BOHLEN Owner 864-987-9700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: SC 6919) |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2010-07-28 |