| NPI | 1265754824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLA MANZIEK Practice Administrator 850-477-8482 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2010-02-24 |
| Last Update Date | 2010-02-24 |