| NPI | 1013179258 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN KEITH BLANKENSHIP Dentist/Owner 904-280-0070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL 193344) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2011-04-06 |