| NPI | 1750432613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARYN RAE Director 843-876-1344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2011-11-30 |