| NPI | 1538183124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON ANDREW STACK President 864-676-0825 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: SC 3618) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2020-08-22 |