| NPI | 1518477686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SYLVIA LOCKLAIR MILLER Insurance Cerdentialing 321-431-2208 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL 17033) |
| Enumeration Date | 2017-10-03 |
| Last Update Date | 2017-10-03 |