| NPI | 1386348787 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS BENTON ROLLINS Owner 850-393-9476 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 122300000X Dentist |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2023-03-29 |
| Last Update Date | 2023-03-29 |