| NPI | 1396797320 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL CHARLES HURST President/Owner 803-469-2060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC SC2501) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2020-08-22 |