Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN24645 | FL |
NPI | 1013369438 |
---|---|
Provider Name | Dr. Michael London |
First Address | Boynton Beach, FL 33473-7806 |
Second Address | Boca Raton, FL 33428-1703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2016 |
Last Update Date | 27/07/2020 |