| NPI | 1790996130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANDON CAMERON MAZYCK Sole Proprietor 850-224-4151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL FL 10797) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2020-08-22 |