| NPI | 1952517161 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN BALLENTINE Associate Academic Prog Director 843-792-2441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: SC SC-3198) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| 1223P0300X Dentist, Periodontics | |
| 1223P0700X Dentist, Prosthodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| 1223G0001X Dentist, General Practice | |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223D0001X Dentist, Dental Public Health | |
| 1223E0200X Dentist, Endodontics | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2025-11-20 |