| NPI | 1235678301 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT KENNY GILDNER Ownder 803-622-5173 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8527) |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2017-02-22 |