| NPI | 1205371259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GENESE DEZILME Practice Consultant Manager 561-752-6304 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2016-12-29 |
| Last Update Date | 2017-01-05 |