| NPI | 1487987087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA S. BROWN Office Manager 803-259-1124 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 3022) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 4609) |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2009-09-14 |