| NPI | 1679978894 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY DONEGAN MCAVOY President 941-366-1010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN16321) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN16999) |
| Enumeration Date | 2014-10-30 |
| Last Update Date | 2014-10-30 |