| NPI | 1336810936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN EVANGELINE JOHNSON Owner 803-606-9011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2021-09-23 |
| Last Update Date | 2023-10-10 |