| NPI | 1508513268 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRION LONG Owner 850-765-3748 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2022-03-03 |
| Last Update Date | 2022-03-24 |