| NPI | 1205920204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVELIS GERENA Accounts Payable 407-629-4444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology | |
| 174400000X Specialist | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2016-06-02 |