| NPI | 1811105588 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN W. FORHAN President 904-772-8898 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN0011258) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2020-08-22 |