| NPI | 1548486566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG STEVEN MODZELEWSKI Owner 843-722-8500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 1313) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 3892) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-08-22 |