| NPI | 1215159058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDERICK H WAGGENER President 321-452-8190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL 10188) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-08-22 |