| NPI | 1740724681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY E. WALTERS General Dentist 863-658-3276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN21053) |
| Enumeration Date | 2016-12-12 |
| Last Update Date | 2016-12-12 |