| NPI | 1538529086 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNIE ROTHWELL Owner/Dentist 843-342-6900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC sc3442) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC sc4160) |
| 1223P0300X Dentist, Periodontics (Licence: SC 8695) | |
| Enumeration Date | 2016-02-26 |
| Last Update Date | 2016-03-05 |