Provider Demographics
NPI:1760722474
Name:ORAL AND FACIAL SURGERY OF FLORIDA, INC.
Entity Type:Organization
Organization Name:ORAL AND FACIAL SURGERY OF FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:MAJID
Authorized Official - Last Name:AZIZI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-756-7172
Mailing Address - Street 1:801 CHAMPION WOODS CT
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-7164
Mailing Address - Country:US
Mailing Address - Phone:407-756-7172
Mailing Address - Fax:
Practice Address - Street 1:19051 US HIGHWAY 441
Practice Address - Street 2:SUITE 104
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6708
Practice Address - Country:US
Practice Address - Phone:407-756-7172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15621261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery