| NPI | 1811361579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA SUZANNE COCKRELL Insurance Coordinator 803-785-9991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 2790) |
| Enumeration Date | 2015-11-18 |
| Last Update Date | 2015-11-18 |