| NPI | 1881729457 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA FITZSIMMONS Office Manager 843-706-2146 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: SC ZX3662) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC ZX3626) |
| 1223G0001X Dentist, General Practice (Licence: SC ZX2779) | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2020-08-22 |