| NPI | 1619424264 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY PAUL GROSS Owner/Doctor 843-342-7700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC DGD4552) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-12 |