| NPI | 1497195721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIA TALALENKO President/Dentist 239-588-0247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL DN20197) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2013-07-01 |