| NPI | 1013237411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CINDY WILSON Mmgr 772-221-3112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN17725) |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2010-06-08 |