| NPI | 1548320138 |
|---|---|
| Doing Business As | 3755 7TH TERRACE SUITE 303 |
| Entity Type | Organization |
| Authorized Contact | NANCY C FREDERICK Business Mgr 772-569-4118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 8492) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 9340) |
| 1223G0001X Dentist, General Practice (Licence: FL 19361) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2014-04-17 |