| NPI | 1699185264 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHYAM SHIVAREDDY Manager 904-514-1217 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT CT10690) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2014-05-05 |