| NPI | 1093806028 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN MARIE DEEDRICK Office Manager 954-474-8977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 17136) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 14352) |
| 1223G0001X Dentist, General Practice (Licence: FL 10331) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2020-08-22 |