| NPI | 1962750935 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN WHITSITT Owner 386-239-7600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL DN 10669) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2012-08-24 |
| Last Update Date | 2012-08-24 |