| NPI | 1992206593 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI EBERHARDT SALOMON Owner 239-304-1900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL DN22050) |
| Enumeration Date | 2018-02-28 |
| Last Update Date | 2018-02-28 |