| NPI | 1518437227 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS HARTER Owner 352-203-4493 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2020-02-11 |