Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN20499 | FL |
NPI | 1053735571 |
---|---|
Provider Name | David Carmona |
First Address | Coral Springs, FL 33071-8072 |
Second Address | Royal Palm Beach, FL 33411-7644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2014 |
Last Update Date | 05/02/2014 |