| NPI | 1235865551 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMIE J MCMULLEN Office Manager 850-479-3355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2022-07-28 |
| Last Update Date | 2022-09-02 |