| NPI | 1740551019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA I PROSPERE Office Manager 813-889-8599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL 10372) |
| Enumeration Date | 2012-01-19 |
| Last Update Date | 2012-01-19 |