| NPI | 1639622988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEAN J MOURSELAS Managing Member 941-624-4000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL Dn16793) |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2016-08-03 |