| NPI | 1063509222 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | E A TILLMAN President 850-682-2408 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 9341) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 3915) |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2020-08-22 |