| NPI | 1114738457 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES ETHEREDGE Owner 561-627-9056 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2025-01-16 |
| Last Update Date | 2025-01-16 |