| NPI | 1225410558 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLENE MENDEZ Owner 843-839-4554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 4406) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: SC 4429) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2015-06-23 |