NPI | 1285844274 |
---|---|
Entity Type | Organization |
Authorized Contact | MARTHA G LAY Office Manager 904-268-2011 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN0010421) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN16658) |
Enumeration Date | 2007-05-22 |
Last Update Date | 2020-08-22 |