| NPI | 1215196761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEMETRICK LECORN Endodontist 352-291-9360 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL DN16008) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2008-06-09 |