Provider Demographics
NPI:1952337586
Name:THEODORE S. SCHWARTZ D.D.S,M.S.D.,P.A.
Entity Type:Organization
Organization Name:THEODORE S. SCHWARTZ D.D.S,M.S.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:SEGAL
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MSD
Authorized Official - Phone:954-473-6900
Mailing Address - Street 1:815 S UNIVERSITY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3312
Mailing Address - Country:US
Mailing Address - Phone:954-473-6900
Mailing Address - Fax:954-724-9406
Practice Address - Street 1:815 S UNIVERSITY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3312
Practice Address - Country:US
Practice Address - Phone:954-473-6900
Practice Address - Fax:954-724-9406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN50611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL771177OtherUNITED CONCORDIA
FL771177OtherUNITED CONCORDIA