| NPI | 1194858159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD LEWIS OWEN Co Owner 863-382-9090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 12378) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2008-12-29 |