| NPI | 1932493640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT JOSEPH RENNER President 803-684-2366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 4294) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 2362) |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2011-05-31 |