| NPI | 1548434087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY I PORTER Doctor/Owner 941-371-3006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 9698) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 13121) |
| 1223G0001X Dentist, General Practice (Licence: FL 16728) | |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2008-04-16 |