| NPI | 1376736967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA GORMAN Lead Dentist 321-637-3646 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: FL DH 17979) |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2007-08-27 |