Provider Demographics
NPI:1164504189
Name:SOUTH FLORIDA ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:SOUTH FLORIDA ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-756-2415
Mailing Address - Street 1:3400 BURNS RD
Mailing Address - Street 2:#103
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410
Mailing Address - Country:US
Mailing Address - Phone:561-624-7116
Mailing Address - Fax:561-624-7026
Practice Address - Street 1:3400 BURNS RD
Practice Address - Street 2:#103
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4325
Practice Address - Country:US
Practice Address - Phone:561-624-7116
Practice Address - Fax:561-624-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty