| NPI | 1124169156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MATTHEW SOLAK President 813-269-2588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: FL 3653) |
| Enumeration Date | 2007-02-11 |
| Last Update Date | 2020-08-22 |