| NPI | 1881741502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACI C. LENNON Dentist 843-873-1202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 3037) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2020-08-22 |