| NPI | 1033373022 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE NELIS GOSLINGA Owner 352-331-7573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 17071) |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2008-07-18 |