| NPI | 1114020294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE J BURNS Office Manager 352-683-1838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DN 8658) |
| Additional Taxonomies | 122300000X Dentist (Licence: DN 16566) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2020-08-22 |