| NPI | 1417969445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON CHRISTOPHER MITCHELL Owner 864-226-8272 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 3611) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 2142) |
| 122300000X Dentist (Licence: SC 4211) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2020-08-22 |