Provider Demographics
NPI:1336436096
Name:BOCA JAW SURGERY, PA
Entity Type:Organization
Organization Name:BOCA JAW SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-499-3331
Mailing Address - Street 1:16110 JOG RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2350
Mailing Address - Country:US
Mailing Address - Phone:561-499-3331
Mailing Address - Fax:
Practice Address - Street 1:16110 JOG RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2350
Practice Address - Country:US
Practice Address - Phone:561-499-3331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15190261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery