| NPI | 1013019124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNIE MISIAK Dentist 863-993-4570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: FL DN16641) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2020-08-22 |