| NPI | 1760085930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW CROUCH VP 321-872-8820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2020-11-19 |
| Last Update Date | 2020-11-19 |