| NPI | 1104504877 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT L DEMINT Credentialing COO Rdinator 813-692-2224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-07-11 |
| Last Update Date | 2023-07-11 |