Provider Demographics
NPI:1013401710
Name:OCEANS DERMATOLOGY, LLC
Entity Type:Organization
Organization Name:OCEANS DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TEO
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAMSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-405-3000
Mailing Address - Street 1:10151 ENTERPRISE CENTER BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3761
Mailing Address - Country:US
Mailing Address - Phone:561-405-3000
Mailing Address - Fax:561-459-1444
Practice Address - Street 1:10151 ENTERPRISE CENTER BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3761
Practice Address - Country:US
Practice Address - Phone:561-235-4222
Practice Address - Fax:561-737-8583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-18
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVLXSPOtherBCBS