NPI | 1316659543 |
---|---|
Entity Type | Organization |
Authorized Contact | ALEXANDER LEVINE Owner 239-310-0000 |
Organization Subpart ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
Enumeration Date | 2022-12-19 |
Last Update Date | 2023-01-31 |