| NPI | 1710085675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN WESLEY TUCKER President 803-648-3266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2022-07-21 |