| NPI | 1841263845 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN ROBERT HEAD Owner 864-233-1234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 2868) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2012-10-31 |