| NPI | 1487869202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARC ROY JOHNSON Partner 813-677-4080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN17531) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN15183) |
| 1223G0001X Dentist, General Practice (Licence: FL dn16752) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2007-08-02 |