| NPI | 1629353941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIVIAN MEDINA Dentist / Owner 813-264-0286 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: FL DN 12750) |
| Enumeration Date | 2011-10-18 |
| Last Update Date | 2011-10-18 |