| NPI | 1003285339 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI CARTER STALLER Practice Administrator 561-495-2099 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223P0300X Dentist, Periodontics | |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2015-09-16 |