| NPI | 1932642634 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE MILLER Office Manager 321-984-7878 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN10353) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: FL DN20799) |
| Enumeration Date | 2016-11-29 |
| Last Update Date | 2016-11-29 |