NPI | 1114291002 |
---|---|
Entity Type | Organization |
Authorized Contact | GARY RASKA President 941-923-0033 |
Organization Subpart ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN18583) |
Enumeration Date | 2012-02-24 |
Last Update Date | 2012-02-24 |