| NPI | 1093243917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN RUSO Member 813-586-0560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2017-05-23 |