| NPI | 1558701177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD WAYNE BLAKE Owner/President 1904-743-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL 0005634) |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2013-06-27 |