| NPI | 1366716490 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA M GRIFFIN CEO 850-249-9311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: FL DN17668) |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2012-03-07 |
| Last Update Date | 2020-01-13 |