| NPI | 1093837932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDSEY S BARNARD Manager 386-775-8707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL 6892) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL 13264) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2020-08-22 |