| NPI | 1992093900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARI ANN RYAN Owner 843-881-1638 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 6906) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2018-12-10 |