| NPI | 1912561432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BILLY BROWN Dentist 863-533-0955 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2019-04-30 |