| NPI | 1447769831 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK KLINE Owner 843-525-0900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: SC 8987) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: SC 2452) |
| Enumeration Date | 2017-09-28 |
| Last Update Date | 2022-07-21 |