| NPI | 1578999462 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SURENDRA G SIRIVOLU Practice Manager 321-278-3933 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL DN17057) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: FL DN17923) |
| Enumeration Date | 2013-09-24 |
| Last Update Date | 2013-09-24 |