| NPI | 1982179818 |
|---|---|
| Doing Business As | PORT ORANGE MODERN DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | MINH B PHAM Owner/Gp 386-259-3905 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2022-08-25 |