Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN11624 | FL |
NPI | 1003006750 |
---|---|
Provider Name | Frederick Kane |
First Address | Miami, FL 33176-1005 |
Second Address | Miami, FL 33176-1005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2007 |
Last Update Date | 30/07/2007 |