| NPI | 1861649386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW G GAMBRELL General Dentist 803-419-5002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 3794) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC SC2116) |
| 122300000X Dentist (Licence: SC 30-04295) | |
| 1223G0001X Dentist, General Practice (Licence: SC 03794) | |
| 122300000X Dentist (Licence: SC 2116) | |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2017-02-21 |