Provider Demographics
NPI:1568095255
Name:BROWARD ORAL SURGERY PA
Entity Type:Organization
Organization Name:BROWARD ORAL SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:AZZOUNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-431-1600
Mailing Address - Street 1:3157 N UNIVERSITY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2258
Mailing Address - Country:US
Mailing Address - Phone:954-431-1600
Mailing Address - Fax:954-432-7994
Practice Address - Street 1:3157 N UNIVERSITY DR STE 104
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-2258
Practice Address - Country:US
Practice Address - Phone:954-431-1600
Practice Address - Fax:954-432-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery