| NPI | 1053709733 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN CRAIGHEAD President 352-263-9579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL DN18965) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL DN18965) |
| Enumeration Date | 2015-01-02 |
| Last Update Date | 2015-01-02 |