| NPI | 1417169707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE ANDERSON WALKER Coowner 803-865-9919 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 4038) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 3984) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2020-08-22 |