Provider Demographics
NPI:1548431026
Name:DIEUDONNE, STEPHANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANE
Middle Name:
Last Name:DIEUDONNE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13765 SW 84TH ST
Mailing Address - Street 2:#E
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4021
Mailing Address - Country:US
Mailing Address - Phone:305-388-5783
Mailing Address - Fax:
Practice Address - Street 1:8000 W BROWARD BLVD
Practice Address - Street 2:SUITE 834
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33388-0024
Practice Address - Country:US
Practice Address - Phone:954-476-0802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN161551223X0400X
GADN0136431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics