| NPI | 1396273025 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER COLEMAN Financial Coordinator 386-672-4325 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL 12420) |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2022-07-21 |