Provider Demographics
NPI:1669227922
Name:BESS, DONTAE
Entity type:Individual
Prefix:
First Name:DONTAE
Middle Name:
Last Name:BESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 CARPENTERS WAY APT 38
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-3941
Mailing Address - Country:US
Mailing Address - Phone:863-258-4116
Mailing Address - Fax:
Practice Address - Street 1:707 CARPENTERS WAY APT 38
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-3941
Practice Address - Country:US
Practice Address - Phone:863-258-4116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle