| NPI | 1316016322 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRICIA LEIGH STANLEY Practice Administrator 941-351-4468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN10983) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN12608) |
| 1223G0001X Dentist, General Practice (Licence: FL DN16079) | |
| 124Q00000X Dental Hygienist (Licence: FL DH6360) | |
| 124Q00000X Dental Hygienist (Licence: FL DH15541) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2017-11-15 |