Provider Demographics
NPI:1376765867
Name:SHORT, STEVEN THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:THOMAS
Last Name:SHORT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5400 N FEDERAL HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3201
Mailing Address - Country:US
Mailing Address - Phone:954-776-6166
Mailing Address - Fax:954-776-6698
Practice Address - Street 1:5400 N FEDERAL HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3201
Practice Address - Country:US
Practice Address - Phone:954-776-6166
Practice Address - Fax:954-776-6698
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL69951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics