NPI | 1902175771 |
---|---|
Entity Type | Organization |
Authorized Contact | MARK PHILLIP KRAVER Owner/Dentist 239-549-8921 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 11408) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 19091) |
Enumeration Date | 2011-12-22 |
Last Update Date | 2011-12-22 |