| NPI | 1568107449 |
|---|---|
| Former Legal Business Name | PROGRESSIVE DENTAL MANAGEMENT, LLC |
| Entity Type | Organization |
| Authorized Contact | NERISSA AQUINO Provider/Owner 772-878-5880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-05-04 |
| Last Update Date | 2022-05-04 |