| NPI | 1235375676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AARON MATTHEW BLILEY Owner 843-524-9020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 3973) |
| Enumeration Date | 2009-01-06 |
| Last Update Date | 2009-01-08 |