| NPI | 1104790674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA CANALEJO HILLER Credentialing Coordinator 813-389-4724 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2025-09-30 |
| Last Update Date | 2025-09-30 |