| NPI | 1538232269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRISH JOHNSON Accounting Bookkeeping 727-786-7551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN9643) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN9640) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2020-08-22 |