NPI | 1386891463 |
---|---|
Former Legal Business Name | J. MICHAEL HAVIRD, DMD, PC |
Entity Type | Organization |
Authorized Contact | JULIE CORLEY Office Manager 803-279-0015 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: SC 2109) |
Enumeration Date | 2008-08-20 |
Last Update Date | 2008-08-20 |