| NPI | 1568114528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA HANSON VACCARIELLO Orthodontist 803-548-4255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-01-21 |
| Last Update Date | 2022-01-21 |