| NPI | 1033661848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NEELY JORDAN Director Of Operations 813-968-2483 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN13285) |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2018-07-23 |