| NPI | 1265402119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA SHELLMAN Manager 904-387-3535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 2333) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2020-08-22 |