| NPI | 1508359340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN DOUGLAS Owner 954-600-5027 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2018-06-06 |