| NPI | 1083238786 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELBY JOEL DENMAN Owner 904-527-1275 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2020-07-17 |