| NPI | 1750096467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAULA BATES Insurance Credential Coordinator 904-256-7854 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-01-17 |
| Last Update Date | 2023-01-17 |