Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 40052 | CA |
N | 122300000X | Dentist | 4698 | NE |
N | 122300000X | Dentist | D8066 | OR |
N | 122300000X | Dentist | D817 | AK |
N | 122300000X | Dentist | DE00009340 | WA |
N | 122300000X | Dentist | DN16119 | FL |
Y | 1223D0001X | Dental Public Health | DN16119 | FL |
NPI | 1609910678 |
---|---|
Provider Name | Ernest Stephen Alder |
First Address | Greenacres, FL 33454-2437 |
Second Address | Pompano Beach, FL 33060-5908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 05/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
075734900 | (05) | FL |