| NPI | 1629288824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS L JOHNSON Owner 904-460-0505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN15568) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN15568) |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: FL DN15568) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2008-06-23 |