| NPI | 1306939228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR RUSSELL GOELLER President Secretary 850-474-1855 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN15157) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2008-07-22 |