| NPI | 1346589579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIM NASIM Owner 864-576-7169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 4457) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 1926) |
| 124Q00000X Dental Hygienist (Licence: SC 3811) | |
| Enumeration Date | 2013-02-07 |
| Last Update Date | 2013-02-07 |