| NPI | 1114025236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL EDWARD DEGROOD Owner 386-775-2025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL 0012305) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-08-22 |