| NPI | 1447360854 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH STEVEN BARRACK Partner President 843-849-9044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: SC 183) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: SC 4169621) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-08-22 |