| NPI | 1124363676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FEDERICO DIEZ Owner 954-505-7631 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN14284) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: FL DN13029) |
| 1223P0300X Dentist, Periodontics (Licence: FL DN14345) | |
| 1223P0700X Dentist, Prosthodontics (Licence: FL DN-14284) | |
| Enumeration Date | 2012-12-10 |
| Last Update Date | 2021-10-11 |