| NPI | 1477936458 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED PRESTON TAVERNIER Principal 864-934-3637 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8591) |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2015-07-08 |