| NPI | 1154863231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES R EVANGER CEO 904-469-3119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 4246) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2017-10-16 |