| NPI | 1609316454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLLEEN P. CONDREY Office Manager 843-552-1600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 6959) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 2785) |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2017-02-27 |