| NPI | 1699928267 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW CARL WATSON President 843-559-5555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 3298) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 3539) |
| 122300000X Dentist (Licence: SC 4360) | |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2008-10-28 |