| 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 |