NPI | 1801140678 |
---|---|
Entity Type | Organization |
Authorized Contact | MARVIN C WELLS President 904-296-2226 |
Organization Subpart ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL 8078) |
Enumeration Date | 2012-11-01 |
Last Update Date | 2012-11-01 |