Provider Demographics
NPI:1104206754
Name:SOUTH FLORIDA CENTER FOR PERIODONTICS & IMPLANT DENTISTRY OF AVENTURA
Entity Type:Organization
Organization Name:SOUTH FLORIDA CENTER FOR PERIODONTICS & IMPLANT DENTISTRY OF AVENTURA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZFAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-944-2700
Mailing Address - Street 1:19495 BISCAYNE BLVD
Mailing Address - Street 2:STE. #402
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2318
Mailing Address - Country:US
Mailing Address - Phone:305-944-2700
Mailing Address - Fax:
Practice Address - Street 1:19495 BISCAYNE BLVD
Practice Address - Street 2:STE. #402
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2318
Practice Address - Country:US
Practice Address - Phone:305-944-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN168911223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty