| NPI | 1821708595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUAN FAJA FERNANDEZ Orthodontist/Business Owner 843-903-3300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-12-02 |
| Last Update Date | 2022-12-02 |