| NPI | 1639430085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRIS MCNEAL Office Manager 561-622-3122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 5685) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 14985) |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2012-06-01 |