| NPI | 1952583924 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MICHAEL REARDEN Owner/Dentist 843-215-2599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 90157) |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2007-12-03 |