| NPI | 1356161293 |
|---|---|
| Former Legal Business Name | MOBILE DENTAL HEAD - START LLC |
| Entity Type | Organization |
| Authorized Contact | KENJULA BROWN Owner 904-300-0126 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2024-10-15 |
| Last Update Date | 2024-10-24 |