| NPI | 1386658284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RODERICK M MACINTYRE Owner 386-252-0858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL DN12743) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2020-08-22 |