| NPI | 1174871644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIE M. VAN Dentist 407-898-3800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN17997) |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2012-08-15 |