| Edward L. Staudt Dds & Kenneth L. Staudt Dds, Mph | |
|
944 Bridgewater Dr. Suite 2-b Port Orange FL 32129 | |
| (386) 756-8953 | |
| Not Available |
| Full Name | Edward L. Staudt Dds & Kenneth L. Staudt Dds, Mph |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 944 Bridgewater Dr., Port Orange, Florida |
| Authorized Official Name and Position | Kenneth Lee Staudt (DENTIST) |
| Authorized Official Contact | 3862147554 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Edward L. Staudt Dds & Kenneth L. Staudt Dds, Mph 944 Bridgewater Dr. Suite 2-b Port Orange FL 32129 Ph: (386) 756-8953 | Edward L. Staudt Dds & Kenneth L. Staudt Dds, Mph 944 Bridgewater Dr. Suite 2-b Port Orange FL 32129 Ph: (386) 756-8953 |
| NPI Number | 1912321654 |
|---|---|
| Provider Enumeration Date | 02/18/2014 |
| Last Update Date | 02/20/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912321654 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN11886 (Florida) | Primary |
| 1223G0001X | Dentist - General Practice | DN9915 (Florida) | Secondary |
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