| NPI | 1871662080 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZACHERY B SHELLEY Office Manager 321-773-7551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 8781) |
| 1223P0221X Dentist, Pediatric Dentistry | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2021-07-30 |