| NPI | 1760938005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLOS MEDINA Ownwe/Dentist 352-753-5789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: FL DN 15845) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2016-08-28 |