| NPI | 1932625035 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN MUCKEY Managing Director 954-494-8502 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2017-08-21 |
| Last Update Date | 2017-08-21 |