| NPI | 1972050490 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNILYN ESTELL Manager 904-704-0867 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 15668) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-01 |