| NPI | 1295279180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY BIWHL Office Manager 803-547-5002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 3644) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 4605) |
| Enumeration Date | 2016-12-12 |
| Last Update Date | 2016-12-12 |