Provider Demographics
NPI:1851473870
Name:SOUTH FLORIDA ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:SOUTH FLORIDA ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-756-2415
Mailing Address - Street 1:1025 MILITARY TRL
Mailing Address - Street 2:#110
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7040
Mailing Address - Country:US
Mailing Address - Phone:561-743-8311
Mailing Address - Fax:561-744-6201
Practice Address - Street 1:1025 MILITARY TRL
Practice Address - Street 2:#110
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7040
Practice Address - Country:US
Practice Address - Phone:561-743-8311
Practice Address - Fax:561-744-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21976Medicare PIN