| NPI | 1407083322 |
|---|---|
| Doing Business As | SOUTHERN TRACE DENTAL |
| Entity Type | Organization |
| Authorized Contact | ROBERT DONNIE LESH Manager 352-751-5777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN15201) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2009-06-18 |