| NPI | 1205132503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE GIBSON Office Manager 904-940-7990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN11714) |
| Enumeration Date | 2011-02-03 |
| Last Update Date | 2011-02-03 |