Organization
EDWARD L. STAUDT DDS & KENNETH L. STAUDT DDS, MPH
Active
Parent organization
EDWARD L. STAUDT DDS & KENNETH L. STAUDT DDS, MPH
Organization subpart
Yes
Provider details
NPI number
Legal business name
EDWARD L. STAUDT DDS & KENNETH L. STAUDT DDS, MPH
Authorized official
DR. KENNETH LEE STAUDT JR. DDS, MPH (DENTIST)
(386) 214-7554
Entity
Organization
Contact information
Practice address
944 BRIDGEWATER DR., SUITE 2-B, PORT ORANGE, FL 32129
(386) 756-8953
Mailing address
944 BRIDGEWATER DR., SUITE 2-B, PORT ORANGE, FL 32129
(386) 756-8953
(386) 756-9184
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN11886
FL
1223G0001X
General Practice Dentistry
DN9915
FL
Other
Enumeration date
02/18/2014
Last updated
02/20/2014
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