| NPI | 1083867584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENDA M CALEY Secretary 772-299-4179 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN14498) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL DN16531) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2008-10-28 |