| NPI | 1679628382 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL D VANOVER President 904-272-2438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 16088) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2020-08-22 |