| NPI | 1679146435 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUDOLPH WAGNER Orthodontist/ Managing Member 727-785-8847 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2021-07-20 |