Individual
DR. THOMAS E STAKEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.,M.D.
Contact information
Practice address
7175-01 U.S. HIGHWAY 17 SOUTH, GREEN COVE SPRINGS, FL 32095
(904) 529-8889
(904) 529-8893
Mailing address
415 SOPHIA TER, ST AUGUSTINE, FL 32095-6839
(904) 529-8889
(904) 529-8893
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN16222
FL
Other
Enumeration date
01/10/2007
Last updated
07/08/2007
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