Provider Demographics
NPI:1457589228
Name:STERRETT, DAVID R (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:STERRETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5817 BROMELIA CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-4797
Mailing Address - Country:US
Mailing Address - Phone:973-652-0853
Mailing Address - Fax:
Practice Address - Street 1:1379 E VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-3603
Practice Address - Country:US
Practice Address - Phone:407-933-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.027935122300000X
FLDN 203641223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist