| NPI | 1316950843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT R. HUMPHREY Owner 843-797-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 2872) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2020-08-22 |