| NPI | 1457791238 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIM VERWEST Owner 239-482-2722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN0012089) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2013-06-26 |