| NPI | 1528439247 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DACHIA RENEE COOPER Orthodontist Asst 904-398-8970 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2015-10-08 |
| Last Update Date | 2015-12-17 |