| NPI | 1528345840 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI BROCK Manager 850-477-1125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL dn12675) |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2011-11-15 |