NPI | 1881707800 |
---|---|
Entity Type | Organization |
Authorized Contact | DENNIS GARY RAITT Dentist President 850-878-0064 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL 5078) |
Enumeration Date | 2006-08-16 |
Last Update Date | 2020-08-22 |