| NPI | 1215052311 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRANK B HINES President Owner 803-359-3733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 2180) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 0241) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2020-08-22 |