| NPI | 1497818629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN TATE CROSBY President 863-683-8127 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN0013748) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2009-11-09 |