| NPI | 1154614758 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUONGVANNAK JB KEO Dentist 321-452-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN 13955) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 19124) |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2011-05-16 |