| NPI | 1326933029 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA CRAWFORD Administrative Support 321-750-9537 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2025-06-11 |
| Last Update Date | 2025-06-11 |