| NPI | 1548403314 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK ALLEN DAVIDSON Owner 813-571-1516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME72794) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 10794) |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2009-04-09 |