| NPI | 1841617438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE M CUSTER Office Administrator 352-861-1500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN14503) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2014-03-21 |
| Last Update Date | 2018-10-24 |