| NPI | 1477858165 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID BURTON FERGUSON Owner 904-994-0410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 24904) |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2011-01-11 |