Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 11165 | FL |
Y | 1223D0001X | Dental Public Health | 11165 | FL |
NPI | 1114029170 |
---|---|
Provider Name | William S Staten |
First Address | Jupiter, FL 33458-5276 |
Second Address | Lantana, FL 33462-1459 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 31/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0736431-00 | (05) | FL |