| NPI | 1700015690 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT M BAKOS Part Owner 239-267-7385 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 1861685158) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 1295928851) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2009-07-13 |