| NPI | 1659944478 |
|---|---|
| Doing Business As | DOCS MAC DILL AFB |
| Entity Type | Organization |
| Authorized Contact | AMANDA ANNE CLARK Director Of Credentialing 813-451-4503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2021-07-20 |