| NPI | 1356668479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROLAND K FULCHER Owner 843-261-7766 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2010-04-29 |