| NPI | 1407215965 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVE D TABORDA Dentist 386-299-5625 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN19830) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN21034) |
| Enumeration Date | 2016-02-12 |
| Last Update Date | 2016-02-12 |