Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN 008100 | FL |
NPI | 1346272713 |
---|---|
Provider Name | Dr. David Lee Stackhouse |
First Address | West Palm Beach, FL 33411-1889 |
Second Address | Belle Glade, FL 33430-5615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 08/07/2007 |