| NPI | 1972048874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WARREN CHRISTOPHER EDWARDS President 321-751-7775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN15965) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN20180) |
| Enumeration Date | 2016-12-31 |
| Last Update Date | 2016-12-31 |