Provider Demographics
NPI:1245773779
Name:NOVA SOUHTEASTERN UNIVERSITY, INC
Entity Type:Organization
Organization Name:NOVA SOUHTEASTERN UNIVERSITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF CONTRACTING AND CRED
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMERY
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTEVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-262-4343
Mailing Address - Street 1:1201 W CYPRESS CREEK RD
Mailing Address - Street 2:2ND FLOOR SUITE 102
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1906
Mailing Address - Country:US
Mailing Address - Phone:954-262-7530
Mailing Address - Fax:954-568-7749
Practice Address - Street 1:1201 W CYPRESS CREEK RD
Practice Address - Street 2:2ND FLOOR SUITE 102
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1906
Practice Address - Country:US
Practice Address - Phone:954-262-7530
Practice Address - Fax:954-568-7749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty