| NPI | 1144762576 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA M BAZZLE Operations Manager 843-871-0842 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8091) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 3352) |
| Enumeration Date | 2016-11-16 |
| Last Update Date | 2017-02-08 |