| NPI | 1265215016 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE JACOMINO-BARNES Director Credentialing & Enrollment 813-270-9497 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2023-08-16 |
| Last Update Date | 2023-09-14 |