| NPI | 1689760571 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRIUCIA FITZSIMMONS Office Manager 843-706-2146 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 3626) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: SC 4005) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2015-08-03 |