| NPI | 1962620120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE A. ITURREGUI President 386-775-7000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN0014097) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN0014097) |
| 1223P0700X Dentist, Prosthodontics (Licence: FL DN0014097) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-08-22 |