| NPI | 1225309602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUCKAPONG DIETER BURR Member 352-223-5459 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL DN19285) |
| Enumeration Date | 2012-01-18 |
| Last Update Date | 2012-01-18 |