| NPI | 1912780461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SERENTHES FIELDS Credentialing Specialist 407-684-3738 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2023-08-17 |
| Last Update Date | 2023-08-17 |