| NPI | 1629101308 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONRAD V HIBBERT Dentist 772-286-2124 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 13088) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2020-08-22 |