| NPI | 1013014000 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOMAS J. BALLESTEROS Owner 352-394-3071 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN0013657) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-08-22 |