| NPI | 1487832341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE CHRISTIAN BENEDICTSON Owner 386-253-1272 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL 7660) |
| Enumeration Date | 2008-02-03 |
| Last Update Date | 2008-02-03 |