| NPI | 1073384277 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER NICOLE VEGA Practice Manager 813-839-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2024-01-16 |
| Last Update Date | 2025-01-22 |