| NPI | 1891364428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCIA MOORE SOSEBEE Insurance Coordinator 843-971-0661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2021-06-18 |