| 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 |