Provider Demographics
NPI:1023160637
Name:WALDING, STEPHEN JUSTICE III (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JUSTICE
Last Name:WALDING
Suffix:III
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 1:3615 S FLORIDA AVE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-4876
Mailing Address - Country:US
Mailing Address - Phone:863-619-6600
Mailing Address - Fax:863-619-6644
Practice Address - Street 1:3615 S FLORIDA AVE
Practice Address - Street 2:SUITE 850
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4876
Practice Address - Country:US
Practice Address - Phone:863-619-6600
Practice Address - Fax:863-619-6644
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN143921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice