| NPI | 1568742351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARLENE COOK Office Manager 850-784-0818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL DN12472) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN12472) |
| 1223G0001X Dentist, General Practice (Licence: FL DN 8483) | |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2011-08-24 |