| NPI | 1063618759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | J KEITH HILLIARD President 863-644-0430 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL 6394) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2020-08-22 |