Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DN7010 | FL |
NPI | 1902913601 |
---|---|
Provider Name | Dr. Diane Stern |
First Address | Ft Lauderdale, FL 33329-0370 |
Second Address | Davie, FL 33328-2018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 25/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
55225 | (02) | FL |