| NPI | 1750103727 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE CARIDE Credentialing Manager 727-784-2721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2024-10-30 |
| Last Update Date | 2024-10-30 |