| NPI | 1558432146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENDON A ROSS Officer 864-882-0620 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 3260) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 3286) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2020-08-22 |