| NPI | 1740389030 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY ELLENBERG President Dentist Owner 727-531-7751 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN11742) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2020-08-22 |