| NPI | 1295023752 |
|---|---|
| Doing Business As | SOUTEL DENTAL CENTER II |
| Entity Type | Organization |
| Authorized Contact | LORRAINE POLITE CLARK Vice President 904-722-2200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 124Q00000X Dental Hygienist |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2019-11-01 |