| NPI | 1518178334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOE BRANCH KENNON Owner 850-769-1034 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 4868) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2020-08-22 |