| NPI | 1851945794 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN LISSAUER President 561-324-4030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2019-07-29 |