Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN0004071 | FL |
NPI | 1063661163 |
---|---|
Provider Name | Dr. Thomas H. Cartledge III |
First Address | Ormond Beach, FL 32174-9505 |
Second Address | Ormond Beach, FL 32174-9505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2008 |
Last Update Date | 12/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0740527 | (05) | FL |