Provider Demographics
NPI:1497228001
Name:HOLLYWOOD ORAL SURGERY, PLLC
Entity Type:Organization
Organization Name:HOLLYWOOD ORAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-792-5544
Mailing Address - Street 1:7500 NW 5TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-1612
Mailing Address - Country:US
Mailing Address - Phone:954-792-5544
Mailing Address - Fax:954-792-5544
Practice Address - Street 1:4420 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3552
Practice Address - Country:US
Practice Address - Phone:954-792-5544
Practice Address - Fax:954-587-6442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty