| NPI | 1235803693 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANN CLAUSSEN CEO 863-291-5110 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2021-08-09 |