| NPI | 1053717322 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE MATHERNE Office Manager 407-328-9492 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN 16360) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN16478) |
| Enumeration Date | 2014-11-13 |
| Last Update Date | 2015-04-16 |