| NPI | 1649892399 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN L MOSS Executive Director 850-431-6256 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2020-05-15 |