| NPI | 1578585451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK DAVID MELLMAN President 813-654-4545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: FL 8712) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2008-07-16 |