| NPI | 1275739237 |
|---|---|
| Doing Business As | SOUTHSIDE DENTAL AT TINSELTOWN |
| Entity Type | Organization |
| Authorized Contact | CRYSTAL L LESS VP Of Operations 904-998-7000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL DN15716) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2015-01-26 |