| NPI | 1225200173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN T ENGEBRETSEN Owner 772-223-0600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN0009427) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2010-04-08 |