| NPI | 1649350349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE KITSON Sec 904-261-7181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN15429) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN3529) |
| 122300000X Dentist (Licence: FL DN17599) | |
| 122300000X Dentist (Licence: FL DN20603) | |
| 122300000X Dentist (Licence: FL DN21208) | |
| 1223E0200X Dentist, Endodontics (Licence: FL DN11327) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2015-12-21 |