| NPI | 1982124681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN DEGARMO President 864-918-5151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 10668) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 9298) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2017-06-23 |