| NPI | 1417118381 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL K WILLIS President 239-936-0181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL FL 4738) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2008-06-23 |