| NPI | 1134539935 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA COLMENARES Practice Manager 239-254-9933 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN15549) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN15449) |
| Enumeration Date | 2014-05-01 |
| Last Update Date | 2014-05-01 |