NPI | 1275951717 |
---|---|
Entity Type | Organization |
Authorized Contact | DENNIS W LICHORWIC Owner/ President 850-654-8665 |
Organization Subpart ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: FL 0014608) |
Additional Taxonomies | 122300000X Dentist (Licence: FL dn19333) |
122300000X Dentist (Licence: FL dn19829) | |
Enumeration Date | 2014-04-02 |
Last Update Date | 2014-04-02 |