| NPI | 1568915387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYDIA CUEVAS Practice Coordinator 904-683-4781 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL DN18280) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL DN16648) |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2016-07-28 |