| NPI | 1144772500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN R WHITE Owner 864-567-0107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2017-04-11 |