| NPI | 1336459064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN OUELLETTE Owner 321-453-7750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN19187) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN19069) |
| 124Q00000X Dental Hygienist (Licence: FL DH17841) | |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2010-10-15 |