| NPI | 1497908727 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY SHULER Insurance Clerk 843-393-5831 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 4128) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 1091) |
| 122300000X Dentist (Licence: SC 1410) | |
| Enumeration Date | 2008-10-30 |
| Last Update Date | 2008-10-30 |