| NPI | 1679960231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA C EAGAN President 305-856-1134 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223P0300X Dentist, Periodontics | |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2015-04-22 |