| NPI | 1265216733 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN DIRA RICAFORT Owner/Orthodontist 904-254-2652 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-08-24 |
| Last Update Date | 2023-08-24 |