| NPI | 1528016573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY IVAN MCCONNELL Owner 843-553-5235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 1759) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2011-04-04 |