| NPI | 1609296276 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIGUEL TABARES President 407-810-0467 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL DN19471) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2014-04-22 |