| NPI | 1154839330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER KEMP Administrator 813-870-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2018-01-22 |
| Last Update Date | 2018-01-22 |