| NPI | 1851557151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL G. STOUTAMIRE V.P. 904-272-2828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN13497) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2008-08-06 |