| NPI | 1083025019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN CAVANAH MIRDA Dentist/ Owner 321-622-6255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN 17649) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2014-05-13 |