| NPI | 1386648863 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEIGH ANN MCILWAIN Owner 813-879-8097 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL 14465) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2019-01-22 |