Provider Demographics
NPI:1508364175
Name:BAL HARBOUR ORAL AND FACIAL SURGERY LLC
Entity Type:Organization
Organization Name:BAL HARBOUR ORAL AND FACIAL SURGERY LLC
Other - Org Name:OPPENHEIMER DENTAL AND SURGICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ORAL & MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ELI
Authorized Official - Middle Name:
Authorized Official - Last Name:OPPENHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-390-8042
Mailing Address - Street 1:3220 STIRLING RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2041
Mailing Address - Country:US
Mailing Address - Phone:954-966-0404
Mailing Address - Fax:
Practice Address - Street 1:3220 STIRLING RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-2041
Practice Address - Country:US
Practice Address - Phone:954-966-0404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN201551223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty