| NPI | 1174648505 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GOODWIN G THOMAS Doctor Owner 803-324-5396 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 2215) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 4206) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2020-08-22 |