| NPI | 1265867691 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD DEAN CARLSON Owner 904-262-8409 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN19024) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN20275) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN18532) | |
| Enumeration Date | 2013-09-04 |
| Last Update Date | 2013-09-04 |