| NPI | 1174839674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANELL CARLOW Bus Mgr 843-722-8500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 4689) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 1313) |
| Enumeration Date | 2010-08-23 |
| Last Update Date | 2010-08-23 |