| NPI | 1417442864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTI LAWRENCE Director, Provider Enrollment 864-522-8611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2022-02-22 |