| NPI | 1225580533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW SCOTT JACKSON Owner 843-672-2444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8657) |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2016-11-03 |