| NPI | 1265930697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRETT M. SHIGLEY Owner 864-714-1800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: SC 8374) |
| Enumeration Date | 2018-01-31 |
| Last Update Date | 2020-12-04 |