| NPI | 1760783468 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS J BOLAND President 727-525-0155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME50633) |
| Enumeration Date | 2010-11-11 |
| Last Update Date | 2010-11-11 |