| NPI | 1033539085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL WARREN ELEY President 321-622-8711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN19369) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN22269) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2016-09-13 |