| NPI | 1558770115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH GRUNDSET Dentist/Owner 727-575-7900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL 4696) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: FL 4596) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2017-04-03 |