| NPI | 1538292081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP MARTINE DRLICKA President 850-455-1323 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL DN12681) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2020-08-22 |