| NPI | 1841365095 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD LEE RIDGELL Doctor 864-232-3882 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: SC 0361) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2020-08-22 |