Provider Demographics
NPI:1285775718
Name:ST PREUX, MACDALIE
Entity type:Individual
Prefix:
First Name:MACDALIE
Middle Name:
Last Name:ST PREUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NA
Other - Middle Name:
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:4205 W ATLANTIC AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3901
Mailing Address - Country:US
Mailing Address - Phone:561-499-7232
Mailing Address - Fax:561-499-4450
Practice Address - Street 1:4205 W ATLANTIC AVE
Practice Address - Street 2:STE 101
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-3901
Practice Address - Country:US
Practice Address - Phone:561-499-7232
Practice Address - Fax:561-499-4450
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN160751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice