| NPI | 1134596166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE GRIGG Business Manager 803-556-0005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OK 6721) |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2019-10-25 |