Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DN 21514 | FL |
NPI | 1093073322 |
---|---|
Provider Name | Dr. Brenton Assing |
First Address | Lithia, FL 33547-4801 |
Second Address | Brandon, FL 33511-4921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2012 |
Last Update Date | 11/08/2015 |