Provider Demographics
NPI:1316085905
Name:LONDON, STEVEN M (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:LONDON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 LAKERIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2181
Mailing Address - Country:US
Mailing Address - Phone:561-852-7700
Mailing Address - Fax:561-852-7700
Practice Address - Street 1:9101 LAKERIDGE BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2181
Practice Address - Country:US
Practice Address - Phone:561-852-7700
Practice Address - Fax:561-852-7700
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13379122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice