| NPI | 1558586362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS NASH President 843-884-0214 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: SC 631) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2008-05-28 |