| NPI | 1376800714 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH M WHITESIDES Managing Member 941-627-2011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN18814) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2012-04-23 |