| NPI | 1295231819 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY CORRAL Owner 904-442-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN17063) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN2788) |
| 1223G0001X Dentist, General Practice (Licence: FL DN14472) | |
| 124Q00000X Dental Hygienist (Licence: FL DH23171) | |
| 124Q00000X Dental Hygienist (Licence: FL DH9959) | |
| 124Q00000X Dental Hygienist (Licence: FL DH24089) | |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2018-04-03 |