| NPI | 1396984878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY TIPPIN Orthodontist 904-261-5811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN008730) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN7025) |
| Enumeration Date | 2009-02-06 |
| Last Update Date | 2009-02-06 |