NPI | 1437785847 |
---|---|
Entity Type | Organization |
Authorized Contact | TYLER M BLACKENBURG Periodontist 954-736-7924 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Additional Taxonomies | 1223P0300X Dentist, Periodontics |
Enumeration Date | 2020-03-17 |
Last Update Date | 2020-03-17 |