| NPI | 1235477506 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID RAY HUDNALL Owner 864-224-8106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 3405) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 3086) |
| Enumeration Date | 2013-01-22 |
| Last Update Date | 2013-01-22 |