Provider Demographics
NPI:1225145261
Name:ADVANCED AESTHETIC CENTER FOR ORAL AND MAXILLOFACIAL SURGERY, INC.
Entity Type:Organization
Organization Name:ADVANCED AESTHETIC CENTER FOR ORAL AND MAXILLOFACIAL SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-659-9990
Mailing Address - Street 1:2239 N COMMERCE PKWY
Mailing Address - Street 2:SUITE #2
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3249
Mailing Address - Country:US
Mailing Address - Phone:954-659-9990
Mailing Address - Fax:954-659-9991
Practice Address - Street 1:2239 N COMMERCE PKWY
Practice Address - Street 2:SUITE #2
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3249
Practice Address - Country:US
Practice Address - Phone:954-659-9990
Practice Address - Fax:954-659-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00132931223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty