| NPI | 1568813491 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANON BOURQUE HUTCHISON Owner 954-570-8870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN13436) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN5044) |
| 1223E0200X Dentist, Endodontics (Licence: FL DN19185) | |
| 1223P0300X Dentist, Periodontics (Licence: FL DN0011990) | |
| 124Q00000X Dental Hygienist (Licence: FL DH15026) | |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2016-06-22 |