| NPI | 1578830147 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BILL WITT Operations Manager 863-510-5960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL dn17074) |
| Enumeration Date | 2011-11-25 |
| Last Update Date | 2011-11-25 |