| NPI | 1831371913 |
|---|---|
| Doing Business As | NORTHSIDE FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | RAYMOND S VICENTE Dentist Owner 843-863-8634 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC SC3976) |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2007-11-30 |