Provider Demographics
NPI:1013292879
Name:SOUTH FLORIDA ORAL AND FACIAL COSMETIC SURGERY
Entity type:Organization
Organization Name:SOUTH FLORIDA ORAL AND FACIAL COSMETIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAWISCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-772-2000
Mailing Address - Street 1:701 E COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3391
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3391
Practice Address - Country:US
Practice Address - Phone:954-772-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN152391223S0112X
FLDN152371223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty