Provider Demographics
NPI:1689171332
Name:SURGICAL ARTS OF BOCA RATON LLC
Entity Type:Organization
Organization Name:SURGICAL ARTS OF BOCA RATON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTNOF
Authorized Official - Suffix:
Authorized Official - Credentials:MD DMD
Authorized Official - Phone:561-717-3660
Mailing Address - Street 1:9980 CENTRAL PARK BLVD N STE 113
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1703
Mailing Address - Country:US
Mailing Address - Phone:561-717-3660
Mailing Address - Fax:561-717-3650
Practice Address - Street 1:9980 CENTRAL PARK BLVD N STE 113
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1703
Practice Address - Country:US
Practice Address - Phone:917-882-5013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty