| NPI | 1700268802 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER J SHANNON Member 352-562-2782 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL 20177) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2015-06-24 |