Provider Demographics
NPI:1801139118
Name:FACIAL ORTHOPEDICS INC
Entity type:Organization
Organization Name:FACIAL ORTHOPEDICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NILSA
Authorized Official - Middle Name:H
Authorized Official - Last Name:TOLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, FAAPD
Authorized Official - Phone:561-215-1603
Mailing Address - Street 1:951 SANSBURYS WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-3619
Mailing Address - Country:US
Mailing Address - Phone:561-215-1603
Mailing Address - Fax:
Practice Address - Street 1:951 SANSBURYS WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-3619
Practice Address - Country:US
Practice Address - Phone:561-215-1603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN174011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75797701Medicaid