| NPI | 1902220320 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE DONALD WATERMAN President 813-689-8462 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: FL DN9391) |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2014-06-27 |