| NPI | 1497082796 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES W WARDNER Dentist 321-269-1242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL 11533) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 9681) |
| Enumeration Date | 2009-11-06 |
| Last Update Date | 2009-11-06 |