| NPI | 1245052729 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE BAZZLE Operations Manager 843-871-0842 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist Dental Public Health |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| 204E00000X Oral & Maxillofacial Surgery | |
| Enumeration Date | 2024-10-28 |
| Last Update Date | 2024-10-28 |