| NPI | 1659321735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LILLIAN D PETERSON Office Manager 803-279-9901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 3364-461) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA 11318) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2008-05-27 |