| NPI | 1881804052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIE R MITCHELL Business Assistant 850-932-2266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN6012) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN4769) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2008-06-10 |