| NPI | 1538552625 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS ALBERT MCDONALD Owner 843-799-4878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 3176) |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2017-01-25 |