| NPI | 1528585924 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUIS P LEITE Owner/President 843-270-6473 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2017-08-25 |