Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DN20422 | FL |
NPI | 1063858603 |
---|---|
Provider Name | Mr. Steven Done Smith |
First Address | Melbourne, FL 32940-1992 |
Second Address | Melbourne, FL 32940-1992 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2013 |
Last Update Date | 09/04/2020 |