| NPI | 1083945711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY M. ELLIS Patner/Owner 863-533-3302 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN10745) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN16931) |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2010-01-20 |