Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN3856 | FL |
N | 1223X0400X | Orthodontists | DN3856 | FL |
NPI | 1023301496 |
---|---|
Provider Name | Dr. Gerald Warren Springstead |
First Address | Brooksville, FL 34601 |
Second Address | Brooksville, FL 34601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2011 |
Last Update Date | 18/05/2011 |