| NPI | 1003096579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SELENA L MARCHAN Owner 904-221-5678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN13459) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2015-03-01 |