| NPI | 1942698204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI MASON Pediatric Dentist 904-372-3260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: FL 17658) |
| Enumeration Date | 2015-01-08 |
| Last Update Date | 2015-01-08 |