| NPI | 1902908338 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE G SHONGO Dentist Practice Owner 803-794-0905 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: SC 2575) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2013-01-31 |