| NPI | 1144986316 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARYAM REZAIE Owner/President 850-385-8101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-11-12 |
| Last Update Date | 2021-11-12 |