| NPI | 1275312068 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SERGE MECHREK Authorized Official 904-729-2866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-09-21 |
| Last Update Date | 2023-10-23 |