| NPI | 1073002259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NEKELDA A WEISS Insurance & Credentialing COO Rdinat 954-715-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: FL DN16336) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN14284) |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2018-05-03 |