| NPI | 1568852010 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM SCOTT WAGNER Owner 904-834-3737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN14961) |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2015-02-04 |