| 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 |