| NPI | 1871677708 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL L WEISEL President 727-536-5787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL DN0010195) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2020-08-22 |