| NPI | 1548415144 |
|---|---|
| Former Legal Business Name | TARA WALLING DMD PA |
| Entity Type | Organization |
| Authorized Contact | TARA M GRIFFIN President/ Owner 850-249-9311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 305S00000X Point of Service (Licence: FL 17668) |
| Enumeration Date | 2008-11-24 |
| Last Update Date | 2020-01-28 |