| NPI | 1568560118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTAN PODVIA Dentist 904-765-5573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL dn0014583) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2013-05-23 |