| NPI | 1205251790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL L LESS VP Of Operations 904-998-7000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics |
| Additional Taxonomies | 122300000X Dentist |
| 1223G0001X Dentist, General Practice | |
| 1223P0300X Dentist, Periodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2014-02-20 |
| Last Update Date | 2015-01-26 |