| NPI | 1720463714 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VINCENT MICHAEL LETH Owner 904-824-3540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN18649) |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2015-07-20 |