| NPI | 1134422744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY R SMITH President 941-747-5597 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: FL DN0008653) |
| Additional Taxonomies | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: FL DN0005357) |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2011-10-14 |