| NPI | 1538586136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA OTTESEN Dentist 850-582-1009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2014-03-21 |
| Last Update Date | 2021-02-15 |