| NPI | 1134585334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR VERGARA Owner Operating Dentist 239-595-0821 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 16089) |
| Enumeration Date | 2016-01-05 |
| Last Update Date | 2016-01-05 |