| NPI | 1508122433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AVANGELA K CRISWELL Business Office Director 843-663-8017 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 124Q00000X Dental Hygienist |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2012-04-04 |