| NPI | 1073941084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMI STRANIGAN Administration 772-340-0805 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN11707) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 122300000X Dentist (Licence: FL DN14820) | |
| 122300000X Dentist (Licence: FL DN15672) | |
| 124Q00000X Dental Hygienist (Licence: FL DH19254) | |
| 124Q00000X Dental Hygienist (Licence: FL DH1940) | |
| 124Q00000X Dental Hygienist (Licence: FL DH19138) | |
| Enumeration Date | 2013-10-30 |
| Last Update Date | 2022-02-17 |