| NPI | 1770925661 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY RENEE NULTY Dentist 941-929-9332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN0014015) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2013-07-22 |