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 |