| NPI | 1578602645 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY JAYE FABRE President 941-792-0944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN14179) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2020-08-22 |