| NPI | 1619248697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS MICHAEL HICKEY Owner 772-359-8962 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN1997) |
| Enumeration Date | 2012-01-23 |
| Last Update Date | 2012-01-23 |