| NPI | 1760502181 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON PHILLIP MAKOWSKI Member 864-675-6445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: SC SC 3724) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2020-08-22 |