| NPI | 1902344948 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZACHARY RYAN KINGSBERG Owner Dentist 954-288-8582 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 31166) |
| Enumeration Date | 2017-02-10 |
| Last Update Date | 2017-02-10 |