| NPI | 1811107501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN DANIEL GARDNER CEO Dentist 843-795-5565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 3668) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2020-08-22 |