| NPI | 1255113932 |
|---|---|
| Former Legal Business Name | DR LOGAN EBERSOLD DMD LLC |
| Entity Type | Organization |
| Authorized Contact | STEPHANIE R MONTUORI Office Manager 803-396-5888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2023-10-18 |
| Last Update Date | 2023-10-18 |