| NPI | 1881141638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEAN JASON MOURSELAS Managing Member 239-530-4000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN16793) |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2016-09-08 |