| NPI | 1447483524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT ALAN JACKSON Member 352-732-8544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN001-4031) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN151-85) |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2009-08-24 |