| NPI | 1922847078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK KOMFORTI Owner 904-201-4844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-05-20 |
| Last Update Date | 2024-05-20 |