| NPI | 1689039869 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY MILLER Office Manager 803-642-0020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: SC 1223S0112X) |
| Enumeration Date | 2015-12-15 |
| Last Update Date | 2015-12-15 |