| NPI | 1962712182 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEROY R POLITE President 904-714-6939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN8243) |
| Enumeration Date | 2010-10-21 |
| Last Update Date | 2010-10-21 |