| NPI | 1871011593 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GABRIELLE F CANNICK Owner/Dentist 864-224-0809 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 4585) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2017-09-01 |
| Last Update Date | 2022-07-21 |