| NPI | 1003112343 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID BURTON FERGUSON President 904-994-0410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 24904) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 24904) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 24904) | |
| Enumeration Date | 2011-02-03 |
| Last Update Date | 2011-02-03 |