| NPI | 1114059425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY S IMHOFF Vice President 813-989-2775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN11782) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2020-08-22 |