| NPI | 1922141274 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PENNY MAHAN Office Manager 407-841-7241 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 9879) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2020-08-22 |