| NPI | 1245465830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID BURTON FERGUSON Managing Member 904-994-0410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 2008028696) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2009-05-26 |