| NPI | 1992806335 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REYNALDO FAVALA GONZALEZ Owner Operator 352-489-0707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: FL DN0011269) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2020-08-22 |