| NPI | 1700802386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON A GOULISH Office Manager 813-855-1007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 10264) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 10076) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2020-08-22 |