| NPI | 1982381810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT CARROLL Owner 803-518-7564 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-07-03 |
| Last Update Date | 2023-12-04 |