| NPI | 1417058843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE H MARTIN Dentist 864-882-2372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 3661) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 1383) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2020-08-22 |