| NPI | 1821798901 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUMAYYA MUJEEB Mgr 321-514-8288 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| Enumeration Date | 2023-03-07 |
| Last Update Date | 2023-05-26 |