| NPI | 1700271053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA EDWARD PERRY President 904-280-1200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN19732) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: FL DN19732) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN19731) | |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2015-06-22 |