NPI | 1811672645 |
---|---|
Entity Type | Organization |
Authorized Contact | MICHELLE JACOMINO-BARNES Director Credentialing & Enrollment 813-270-9497 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Enumeration Date | 2023-06-20 |
Last Update Date | 2023-09-14 |