| NPI | 1225421662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIRIN THANASASAVAT Dentist 407-412-7887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN17989) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN17990) |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2015-03-10 |