| NPI | 1174642375 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE ADRIAN HAEUSSNER President 904-264-2483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN 6384) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2020-08-22 |