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General NPI Number Information
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NPI Number | 1396840252
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Entity Type | Organization
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Legal Business Name | STEPHEN H WANDER, DDS, PA
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12301 TAFT ST #300
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-4387
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Country | US
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Telephone | 954-962-8311
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Fax |
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Provider Business Mailing Address
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Address Line | 12301 TAFT ST #300
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-4387
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Country | US
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Telephone | 954-962-8311
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN H WANDER
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Credential | DDS
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Telephone | 954-962-8311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 4723
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License Number State | FL
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