| 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 |