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General NPI Number Information
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NPI Number | 1629107602
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Entity Type | Individual
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Provider Name | STEVEN CRAIG MCNUTT D.D.S., P.A.
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 320 AVENUE K SE SUITE #2
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City | WINTER HAVEN
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State | FL
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Zip | 33880-4147
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Country | US
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Telephone | 863-294-6565
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Fax | 863-295-9164
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Provider Business Mailing Address
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Address Line | 320 AVENUE K SE SUITE #2
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City | WINTER HAVEN
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State | FL
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Zip | 33880-4147
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Country | US
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Telephone | 863-294-6565
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Fax | 863-295-9164
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN 12177
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License Number State | FL
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