| NPI | 1376798280 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMIAH MAHONEY Treasurer 386-446-3883 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN16989) |
| Enumeration Date | 2008-11-19 |
| Last Update Date | 2010-01-05 |