| NPI | 1679990501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS WAYNE LICHORWIC Owner/President 850-654-8665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL 0014608) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL dn19333) |
| 122300000X Dentist (Licence: FL dn19829) | |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2014-03-28 |