| NPI | 1619337722 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL VANDERLIND Office Staff 864-437-8606 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: SC 3638) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry |
| Enumeration Date | 2016-03-02 |
| Last Update Date | 2016-03-02 |