NPI | 1578612925 |
---|---|
Entity Type | Organization |
Authorized Contact | CHARLES MACON WALLACE Owner President 239-643-4746 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN14024) |
Enumeration Date | 2007-01-08 |
Last Update Date | 2010-09-29 |