| 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 |