| NPI | 1144626136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIM H TRUONG Manager 813-961-1032 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN16638) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN19971) |
| Enumeration Date | 2014-11-18 |
| Last Update Date | 2014-11-18 |