| NPI | 1447671771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH BRYAN WINGATE Partner 803-792-0965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8221) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 8220) |
| 1223G0001X Dentist, General Practice (Licence: SC 1924) | |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2014-01-06 |