| NPI | 1457994196 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA E BAZZLE Operations Manager 843-871-0842 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2019-10-25 |
| Last Update Date | 2021-02-04 |