| NPI | 1821294984 |
|---|---|
| Former Legal Business Name | D/B/A CHANEY COUCH & GROOTERS FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | ANGELA KAYE HOLLIFIELD Office Manager 850-877-0215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN8129) |
| 122300000X Dentist (Licence: FL DN16145) | |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2020-04-29 |