| NPI | 1467800714 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETH LOUISE ILLSLEY Director Of Insurance 864-282-1935 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2023-01-09 |