| NPI | 1487191094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD CHANDLER MULLENS Managing Member 904-399-3163 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL DN 12370) |
| Enumeration Date | 2017-01-22 |
| Last Update Date | 2017-01-22 |