| NPI | 1386699288 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE M MONTES Insurance Coordinator 803-254-2972 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 1788) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2020-08-22 |