| NPI | 1720144314 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORNELIUD JONATHAN BECK Owner 843-492-4090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: SC 2222) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2020-08-22 |