| NPI | 1255980447 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE COLE VP Insurance Plan Management 941-955-3150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2020-01-29 |