| NPI | 1053499756 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAT RICALDE Owner 813-870-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME88289) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL DN16594) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2015-07-15 |