| NPI | 1598979122 |
|---|---|
| Doing Business As | SOUTH LAKE DENTAL |
| Entity Type | Organization |
| Authorized Contact | CARLA PATRICIA TALAVERA-JORDAN President 352-242-0912 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN 16454) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2011-11-26 |