| NPI | 1366710022 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BILL WITT Operations Manager 863-510-5960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN17074) |
| Enumeration Date | 2011-12-09 |
| Last Update Date | 2011-12-09 |