| NPI | 1881137842 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN KOVALESKI Manager 850-769-2722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN19214) |
| Enumeration Date | 2016-11-23 |
| Last Update Date | 2016-11-23 |