MEDICARE: STEVEN MUCKEY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN8582	FL

General Provider Information

NPI Number	:	1386032803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN MUCKEY DDS

Provider Business Mailing Address
First Line	:	15 SARANAC RD
Second Line	:
City	:	SEA RANCH LAKES
State	:	FL
Zip	:	33308-2910
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3012 E COMMERCIAL BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4356
Country	:	US
Telephone Number	:	954-491-7100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2015
Last Update Date	:	01/06/2015

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Directions to “ STEVEN MUCKEY DDS” Practice Location

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