| NPI | 1265906127 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAD ANDREW PODRAY Owner 561-699-2580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-01-14 |
| Last Update Date | 2019-01-14 |