Provider Demographics
NPI:1376890673
Name:SOUTH FLORIDA DENTAL SURGICAL SPECIALISTS PA
Entity Type:Organization
Organization Name:SOUTH FLORIDA DENTAL SURGICAL SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:F
Authorized Official - Last Name:ELLIOT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-340-6550
Mailing Address - Street 1:9600 W SAMPLE RD
Mailing Address - Street 2:SUITE 504
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4045
Mailing Address - Country:US
Mailing Address - Phone:954-340-6550
Mailing Address - Fax:
Practice Address - Street 1:9600 W SAMPLE RD
Practice Address - Street 2:SUITE 504
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4045
Practice Address - Country:US
Practice Address - Phone:954-340-6550
Practice Address - Fax:954-340-8488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 114431223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty