| NPI | 1124364971 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEROY RONALD POLITE President 904-714-6939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL DN8243) |
| Enumeration Date | 2012-12-26 |
| Last Update Date | 2012-12-26 |