| NPI | 1841667037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT LAFORREST SHOUN Dentist/Owner 803-348-8976 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 3801) |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2015-08-24 |