| NPI | 1386079549 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS BOGART Owner 352-344-9500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL 10453) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2013-09-06 |
| Last Update Date | 2013-09-06 |