| NPI | 1558470450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN EDWARD ISEMAN Owner President 843-449-4372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 2995) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 3771) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-08-22 |