| NPI | 1205176021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRODIE BOWMAN Owner 850-863-2122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL 16286) |
| Enumeration Date | 2013-02-15 |
| Last Update Date | 2013-02-15 |