| NPI | 1740381698 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID ALAN THEIS Owner, President 386-789-5100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN 5761) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-08-22 |