| NPI | 1982150934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE TAMMY Administrative Specialist 352-273-5688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2016-08-30 |