| NPI | 1528217734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OTIS GLENN BECK, JR Owner 850-656-2636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 8116) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 9826) |
| Enumeration Date | 2008-09-11 |
| Last Update Date | 2017-07-13 |