| NPI | 1730951435 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHADWICK MARSHALL Credentialing Specialist 850-269-7550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2023-10-25 |
| Last Update Date | 2023-10-25 |