| NPI | 1518983162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND FANNIN REID Dentist 813-935-7226 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 4685) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2020-08-22 |