| NPI | 1528172160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY WELTY BOWDEN CEO 904-777-5878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL dn00009989) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2020-08-22 |