| NPI | 1649641077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE ENDRIS Operations Manager 727-202-1053 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL 13292) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 13292) |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2015-10-12 |