Provider Demographics
NPI:1932653524
Name:FLORIDA DENTAL SLEEP GROUP PLLC
Entity Type:Organization
Organization Name:FLORIDA DENTAL SLEEP GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORNARIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-493-7084
Mailing Address - Street 1:5727 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2201
Mailing Address - Country:US
Mailing Address - Phone:786-493-7084
Mailing Address - Fax:
Practice Address - Street 1:5727 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2201
Practice Address - Country:US
Practice Address - Phone:786-493-7084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental