| NPI | 1346362936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN W DRAPER President 904-745-5115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 11061) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 15445) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2020-08-22 |