| NPI | 1811311533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL B BARRON Insurance Direct Supervisor 813-977-6962 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2014-02-17 |
| Last Update Date | 2014-02-18 |