| NPI | 1316340839 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWIGHT JULIUS BEAVERS Member 843-871-9070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 2560) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2014-09-29 |