| NPI | 1720408917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CINDY LOYAL Office Manager 941-921-7055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: FL DN16194) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN16194) |
| Enumeration Date | 2014-04-26 |
| Last Update Date | 2015-04-07 |