| NPI | 1235403817 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL G BLEDSOE Operations Assistant 863-510-5960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN17074) |
| Enumeration Date | 2012-02-29 |
| Last Update Date | 2012-02-29 |