Provider Demographics
NPI:1457502874
Name:DADELAND ORAL SURGERY ASSOCIATES, PA
Entity Type:Organization
Organization Name:DADELAND ORAL SURGERY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:RICKY
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-670-7610
Mailing Address - Street 1:8950 SW 74TH CT STE 1610
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3175
Mailing Address - Country:US
Mailing Address - Phone:305-670-7610
Mailing Address - Fax:305-670-4950
Practice Address - Street 1:8950 SW 74TH CT STE 1610
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-3175
Practice Address - Country:US
Practice Address - Phone:305-670-7610
Practice Address - Fax:305-670-4950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN117761223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty