| NPI | 1154712818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW CLARK President 850-385-2822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL 19032) |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2015-02-16 |