Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 5808 | FL |
NPI | 1003871781 |
---|---|
Provider Name | Dr. Bruce M. Mahaffey |
First Address | Village Of Palmetto Bay, FL 33176-7218 |
Second Address | Village Of Palmetto Bay, FL 33176-7218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
70054 | (05) | FL |