| NPI | 1528271368 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW C. WATSON Owner 843-556-6575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 3298) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 3539) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2007-08-14 |