| NPI | 1558595926 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALINA O. PORCELLI Office Manager 843-524-6363 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: SC 4530) |
| Enumeration Date | 2009-05-13 |
| Last Update Date | 2009-05-13 |