| NPI | 1548303373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORA B. EVANS P.A. Secretary 803-484-6041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 1623) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2007-07-17 |