| NPI | 1043708050 |
|---|---|
| Doing Business As | KEVIN MARVIN |
| Entity Type | Organization |
| Authorized Contact | EUGENE JOSEPH LECOMPTE Owner/Manager 386-295-3815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL DN7283) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: FL DN12922) |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2018-04-25 |