| NPI | 1942650585 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETH LOUISE ILLSLEY Director Of Insurance 864-282-1935 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2023-01-09 |