| NPI | 1457740789 |
|---|---|
| Doing Business As | EAU CLAIRE FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | DELGAOD CANTAVE CEO 803-733-5969 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2015-01-09 |
| Last Update Date | 2022-02-03 |