| NPI | 1013141217 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY J PARKER Owner 904-737-3263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN0010957) |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2013-01-15 |