NPI | 1528441003 |
---|---|
Entity Type | Organization |
Authorized Contact | MCKINZIE DAWN JEFFREY Owner 850-678-4151 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
Enumeration Date | 2015-07-02 |
Last Update Date | 2024-07-30 |