| NPI | 1922082486 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH BENJAMINE ROGERS Director 863-293-0636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN11515) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2020-08-22 |