| NPI | 1215272646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA JO KELLER President 904-631-6808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN 10773) |
| Enumeration Date | 2012-12-12 |
| Last Update Date | 2012-12-12 |