| NPI | 1225333172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINGER GRAY Office Manager 843-662-3505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 2753) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 4047) |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2011-01-24 |