| NPI | 1629323126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTAL MYERS TEAGUE Dentist 803-684-6545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 4599) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 4367) |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2012-07-20 |