Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DN18020 | FL |
NPI | 1134328172 |
---|---|
Provider Name | Dr. Diana Bronstein |
First Address | Wimauma, FL 33598-5566 |
Second Address | Wimauma, FL 33598-5566 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2007 |
Last Update Date | 27/06/2021 |