SpecialtyGeneral Dentist
LocationFort Walton Beach, FL
NPI1124530191
License statusActive
License number13722
License expires02/28/2026
Disciplinary recordClear
Last verified by WhoIsMyDentist: 2026-07-17. Sourced from the U.S. federal NPI registry and state dental board licensing (federal record dated 10/31/2017). If this looks outdated, use "Report an issue" on this profile to suggest a correction.