| NPI | 1811377120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON CHRISTOPHER MITCHELL President 864-226-8272 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 3611) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 4399) |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2015-06-02 |