Individual
DR. KENNETH LEE STAUDT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MPH
Contact information
Practice address
944 BRIDGEWATER DR, #2B, PORT ORANGE, FL 32129
(386) 756-8953
(386) 756-9184
Mailing address
944 BRIDGEWATER DR, #2B, PORT ORANGE, FL 32129
(386) 756-8953
(386) 756-9184
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN00011886
FL
Other
Enumeration date
05/01/2007
Last updated
07/08/2007
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