| NPI | 1861163032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY MUSCARO Manager 813-230-0853 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223P0300X Dentist, Periodontics | |
| 1223P0700X Dentist, Prosthodontics | |
| Enumeration Date | 2021-09-27 |
| Last Update Date | 2022-04-11 |