| NPI | 1770006876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA MARIE BAZZLE Operation Manager 843-871-0842 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 8526) |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2017-07-20 |