| NPI | 1972640563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY MICHAEL KELLY Owner Dentist 813-745-3968 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL DN11407) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2020-08-22 |