| NPI | 1215387683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETH LOUISE ILLSLEY Director Of Insurance 864-282-1935 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2024-04-09 |