| NPI | 1992114029 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE DEFELICE HUCKE President/CEO 904-501-9178 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN16151) |
| Enumeration Date | 2014-08-02 |
| Last Update Date | 2014-08-02 |