Provider Demographics
NPI:1942255211
Name:MAHAN, STEWARD KEITH (DDS)
Entity Type:Individual
Prefix:
First Name:STEWARD
Middle Name:KEITH
Last Name:MAHAN
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 1:1224 SLIGH BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1108
Mailing Address - Country:US
Mailing Address - Phone:407-841-7241
Mailing Address - Fax:407-849-6252
Practice Address - Street 1:1224 SLIGH BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1108
Practice Address - Country:US
Practice Address - Phone:407-841-7241
Practice Address - Fax:407-849-6252
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL98791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice