| NPI | 1912321654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH LEE STAUDT Dentist 386-214-7554 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN11886) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN9915) |
| Enumeration Date | 2014-02-18 |
| Last Update Date | 2014-02-20 |