| NPI | 1821404914 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON LEE Owner 904-444-1578 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN18554) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2025-01-07 |