| NPI | 1255938320 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES BRADLEY WISNER Owner/Dentist 843-722-1676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2020-10-02 |
| Last Update Date | 2020-10-13 |