Individual
KENNETH LEE STEPHEN III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3216 W SAN MIGUEL ST, TAMPA, FL 33629-5949
(216) 701-4023
Mailing address
3216 W SAN MIGUEL ST, TAMPA, FL 33629-5949
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
30270
FL
Other
Enumeration date
06/25/2025
Last updated
06/25/2025
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