| NPI | 1790825289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN A GRADDY President Dentist 813-221-0010 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN4964) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2011-12-01 |