| NPI | 1639957251 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SERENTHES FIELDS Credentialing Specialist 407-684-3738 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-09-15 |
| Last Update Date | 2023-09-15 |