| NPI | 1811182231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD MICHAEL CONWAY President 772-569-4118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 8492) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 9340) |
| 1223G0001X Dentist, General Practice (Licence: FL 17124) | |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2007-09-10 |