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 |