| NPI | 1508313198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA KNOWLTON Insurance Coordinator 941-924-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN11060) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-01 |