| NPI | 1275799546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY ROBERT LIPTAK Owner 843-577-6376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 4299) |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2010-08-23 |