| NPI | 1871822957 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE JAY FARNSWORTH Owner/President 843-986-0157 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 3813) |
| Enumeration Date | 2009-12-18 |
| Last Update Date | 2012-05-14 |