Provider Demographics
NPI:1871513184
Name:ORAL AND FACIAL SURGERY CENTER
Entity Type:Organization
Organization Name:ORAL AND FACIAL SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAL
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:407-352-6301
Mailing Address - Street 1:200 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4420
Mailing Address - Country:US
Mailing Address - Phone:407-932-0883
Mailing Address - Fax:407-932-4251
Practice Address - Street 1:200 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4420
Practice Address - Country:US
Practice Address - Phone:407-932-0883
Practice Address - Fax:407-932-4251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty