| NPI | 1023480092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN C TAYLOR Owner 941-926-4800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN16457) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN21003) |
| Enumeration Date | 2015-10-29 |
| Last Update Date | 2015-10-29 |