| NPI | 1619281490 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDERICK A VANCE Owner 813-908-2444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN11721) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN10483) |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2010-08-04 |