| NPI | 1982773669 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN SHEFTALL Owner 803-772-1548 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 200639953147) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2020-08-22 |