| NPI | 1053662395 |
|---|---|
| Doing Business As | LAKE QUALITY DENTAL |
| Entity Type | Organization |
| Authorized Contact | PHUONG TA President / Owner 352-255-5538 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL ND14668) |
| Enumeration Date | 2012-09-26 |
| Last Update Date | 2012-09-26 |