| NPI | 1841625910 |
|---|---|
| Doing Business As | LAKES PARK CHILDREN'S DENTISTRY & ORTHODONTICS |
| Entity Type | Organization |
| Authorized Contact | OLIVER P FAVALLI Owner/Doctor 239-418-1444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN13738) |
| Enumeration Date | 2013-09-09 |
| Last Update Date | 2013-09-09 |