| NPI | 1033804828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE REEDER HENLEY Owner 352-318-8660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2023-04-07 |
| Last Update Date | 2023-06-21 |