| NPI | 1396619896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA CANALEJO HILLER Credentialing COO Rdinator 813-389-4724 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2025-09-30 |
| Last Update Date | 2025-09-30 |