| NPI | 1821024522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY A DETTORI Dentist/Owner 772-221-3700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN12143) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2016-03-18 |