Provider Demographics
NPI:1710921036
Name:SCLAR ORAL SURGERY PA
Entity Type:Organization
Organization Name:SCLAR ORAL SURGERY PA
Other - Org Name:SOUTH FLORIDA OMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDENA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-661-5297
Mailing Address - Street 1:7600 S RED RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5428
Mailing Address - Country:US
Mailing Address - Phone:305-661-5297
Mailing Address - Fax:305-667-3503
Practice Address - Street 1:7600 S RED RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5428
Practice Address - Country:US
Practice Address - Phone:305-661-5297
Practice Address - Fax:305-667-3503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN80521223S0112X
FLDN00101511223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT55262Medicare UPIN
FLDS671AMedicare PIN