| NPI | 1245320449 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK LESTER MCCLENDON President/Owner 863-494-6116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN0011846) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2020-08-22 |