| NPI | 1346406733 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY D RICKBORN Owner 803-731-0803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC sc2345) |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2008-08-05 |