| NPI | 1417110537 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTELLE TERRY DUVERT Dentist 813-849-3695 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 16987) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2008-07-09 |