| NPI | 1215208707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANEEN M GORMAN Manger 352-684-1274 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN7162) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN17567) |
| 1223G0001X Dentist, General Practice (Licence: FL DN17081) | |
| Enumeration Date | 2012-01-16 |
| Last Update Date | 2012-01-16 |