| NPI | 1104475300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE COLE VP Insurance Plan Management 941-955-3150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2019-09-10 |