Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN24404 | FL |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DS028494L | PA |
N | 204E00000X | Oral & Maxillofacial Surgeon | DS028494L | PA |
NPI | 1164514402 |
---|---|
Provider Name | Dr. Steven D Sudbrink |
First Address | Orlando, FL 32833-5624 |
Second Address | Ephrata, PA 17522-1635 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 04/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U42077 | (02) |