| NPI | 1215202502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONRAD JAMES KUSEL President 772-878-7525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN-0011106) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2012-03-20 |