| NPI | 1417389883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS CLINTON GOSS Owner 239-262-4595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN10506) |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2013-08-07 |