| NPI | 1811071293 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | A G BURRIS President 843-525-6228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 1615) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2020-08-22 |