| NPI | 1225458763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL BRADLEY JERGINS Owner/Operator 727-791-8823 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL DN15034) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2023-03-07 |