| NPI | 1952855470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID ALAN WAGNER Owner/Dentist 727-797-5161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN13625) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: FL DN13625) |
| Enumeration Date | 2016-08-12 |
| Last Update Date | 2017-02-28 |