| NPI | 1295455210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW CROUCH VP 321-872-8820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223P0300X Dentist, Periodontics | |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2022-08-30 |