| NPI | 1669993812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUSTIN GARDNER WEBB Owner 352-339-4911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NC 10446) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2022-07-21 |