| NPI | 1679773899 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY ANN WIGGINS Office Manager 843-881-1418 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 3298) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 3539) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2008-03-24 |