| NPI | 1124110200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANCE WILLIAM GODLEY President 239-262-1535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL dn14581) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2022-07-21 |