Provider Demographics
NPI:1295974293
Name:BROWARD CHILDREN'S CENTER
Entity type:Organization
Organization Name:BROWARD CHILDREN'S CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:OLLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-262-4343
Mailing Address - Street 1:3200 S UNIVERSITY DR
Mailing Address - Street 2:ASSEMBLY BLDG # 2 ROOM 202
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-2018
Mailing Address - Country:US
Mailing Address - Phone:954-262-4343
Mailing Address - Fax:954-262-2269
Practice Address - Street 1:200 SE 19TH AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7543
Practice Address - Country:US
Practice Address - Phone:954-943-7638
Practice Address - Fax:954-943-5950
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOVA SOUTHEASTERN UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty