| NPI | 1184698045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOIS DERMODY Manager 772-562-5150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2020-08-22 |