| NPI | 1881978690 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLEN S DAVIS Owner 864-801-3500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 6958) |
| Enumeration Date | 2011-09-29 |
| Last Update Date | 2011-09-29 |