| NPI | 1487766838 |
|---|---|
| Doing Business As | MAIN STREET ORTHODONTICS OF JUPITER |
| Entity Type | Organization |
| Authorized Contact | STEPHANIE GOMEZ Provider Relations 305-274-2499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2014-08-21 |