| NPI | 1154807600 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATTY REYER Office Manager 772-567-2111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 19761) |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2018-07-18 |