| NPI | 1255362877 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROGER J PHANOD Owner And Doctor 305-685-7863 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN0014809) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN0011236) |
| 1223E0200X Dentist, Endodontics (Licence: FL DN0011339) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2020-08-22 |