| 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 |