| NPI | 1508295767 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE MAPP Owner/President 904-543-0568 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN 13848) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN19375) |
| Enumeration Date | 2013-11-07 |
| Last Update Date | 2013-11-07 |