| NPI | 1306525399 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANNA LYNN SCHAFFER Manager/Authorized Official 386-218-3316 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| 261QH0100X Clinic/Center Health Service | |
| 261QS0112X Clinic/Center Oral and Maxillofacial Surgery | |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2025-06-05 |