| NPI | 1447969928 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE COLE VP Insurance Plan Management 727-424-2990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2022-11-23 |
| Last Update Date | 2024-07-30 |