| NPI | 1396963443 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZANNE SPROUSE POWELL Co Owner/General Dentist 843-761-8065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 3119 SC) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 1641 SC) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2023-09-19 |