| NPI | 1265538367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLEY LYNN BORDERS Owner 813-754-2605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN 16284) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 7245) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2020-08-22 |