| NPI | 1912017997 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENDON A ROSS Corporate Officer 864-224-1925 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 3286) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 3260) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-08-22 |