| NPI | 1982324778 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE JOHN GRELLNER Owner 813-972-3478 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2022-08-31 |
| Last Update Date | 2022-08-31 |