| NPI | 1386030351 |
|---|---|
| Former Legal Business Name | VICTORY PEDIATRIC DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | TASHIA MCDONALD Manager 803-228-0525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: SC 4382) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2015-04-07 |