Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN25857 | FL |
NPI | 1508432428 |
---|---|
Provider Name | Dr. Michael Sofianos JR. |
First Address | Lake Worth, FL 33463-7917 |
Second Address | Moore Haven, FL 33471-6206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2021 |
Last Update Date | 01/06/2021 |