| NPI | 1164881835 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE CARIDE Credentialing Manager 727-784-2721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2016-02-23 |
| Last Update Date | 2025-10-23 |