| NPI | 1518388545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY SHAEFFER VP 904-230-4567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN16623) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN16384) |
| Enumeration Date | 2013-12-17 |
| Last Update Date | 2014-07-30 |