| NPI | 1225327430 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROXANN RUSSELL AVES Ped. Dentist/Managing Partner 813-885-4501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN18794) |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2011-03-29 |