Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DN 7020 | FL |
NPI | 1245591361 |
---|---|
Provider Name | Dr. Stephen Teitelbaum |
First Address | Boca Raton, FL 33433-3424 |
Second Address | Boca Raton, FL 33433-3424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2012 |
Last Update Date | 05/06/2012 |