| NPI | 1407539133 |
|---|---|
| Doing Business As | PINE AVENUE SMILES |
| Entity Type | Organization |
| Authorized Contact | MICHELLE PAN Office Manager 813-855-1007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2023-08-09 |