| NPI | 1073024006 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN KEITH BLANKENSHIP President 904-210-5348 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL 16941) |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2017-10-17 |