| NPI | 1194877175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEABORN MICHAEL THURMAN Owner 843-884-6166 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 1834) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: SC 3170) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2020-08-22 |