| NPI | 1629742226 |
|---|---|
| Doing Business As | PATRIOT DENTAL |
| Entity Type | Organization |
| Authorized Contact | JOHN KEITH LISONBEE CEO 850-758-1844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-08-06 |
| Last Update Date | 2021-08-06 |