| NPI | 1508084609 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI PONCE Office Manager 954-427-4287 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL 08490) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL 15174) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL 13518) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL 14521) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-08-22 |