| NPI | 1053606178 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN TODD VANAELST Periodontist 813-988-1103 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN16867) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2011-06-16 |