| NPI | 1629668538 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA BAZZLE Operations Manager 843-871-0843 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QS0112X Clinic/Center Oral and Maxillofacial Surgery |
| Enumeration Date | 2021-01-25 |
| Last Update Date | 2021-01-25 |