| NPI | 1811632029 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN N. GILREATH Owner 843-810-0109 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223P0300X Dentist, Periodontics | |
| 1223P0700X Dentist, Prosthodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2022-05-02 |
| Last Update Date | 2022-05-02 |