| NPI | 1205550977 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA DENT Director Of Operations 904-537-1003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2022-09-27 |
| Last Update Date | 2022-09-27 |