| NPI | 1093815029 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN F CERVENKA Owner 407-248-0100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL 14090) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 9168) |
| 1223G0001X Dentist, General Practice (Licence: FL 13762) | |
| 1223G0001X Dentist, General Practice (Licence: FL 14238) | |
| 1223G0001X Dentist, General Practice (Licence: FL 16360) | |
| 1223P0300X Dentist, Periodontics (Licence: FL 12525) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2020-08-22 |