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General NPI Number Information
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NPI Number | 1669885752
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Entity Type | Organization
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Legal Business Name | STEPHANE DIEUDONNE DDS, PA
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 06/05/2014
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Provider Practice Location Address
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Address Line | 14824 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1222
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Country | US
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Telephone | 305-388-5783
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Fax |
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Provider Business Mailing Address
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Address Line | 14824 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1222
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/ORTHODONTIST
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Name | DR. STEPHANE DIEUDONNE
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Credential | D.D.S
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Telephone | 305-388-5783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN16155
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License Number State | FL
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