| NPI | 1891801700 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ANTONIE GOEDECKE Dentist 843-971-9594 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 3498) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2020-08-22 |