| NPI | 1366038499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAPHAEL LIY Manager 727-848-5525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-12-13 |
| Last Update Date | 2021-02-02 |