| NPI | 1922515204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA WHITAKER Office Manager 386-276-9051 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN15016) |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2024-06-12 |