| NPI | 1093136004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL A TARVER Manager 863-899-1617 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL DN18670) |
| Enumeration Date | 2013-12-17 |
| Last Update Date | 2013-12-17 |