| NPI | 1265918312 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOLLY KAY Vice President 727-251-1907 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN11998) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN19345) |
| 122300000X Dentist (Licence: FL DN19494) | |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2018-07-12 |