| NPI | 1952587644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDGAR HAROLD PEACOCK President 803-256-9268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 1545/OS161) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2008-01-14 |