| NPI | 1164721510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY A NELSON Owner 813-733-4169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN10809) |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2021-08-24 |