| NPI | 1194812339 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILMA POND Practice Administrator 843-448-1621 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2024-04-11 |