| NPI | 1023602315 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIRLEY MAYSONET Business Manager 772-569-4118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2021-02-26 |
| Last Update Date | 2021-03-04 |