| NPI | 1588656656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE ANN SPROGIS Vice President Of My Corporation 864-271-6215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 2548) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2020-08-22 |