Broward County Dental Surgery Pa | |
5181 Ne 19 Ave Ft Lauderdale FL 33308 | |
(954) 562-9610 | |
(954) 772-2569 |
Full Name | Broward County Dental Surgery Pa |
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Speciality | Dentist - Oral And Maxillofacial Surgery |
Location | 5181 Ne 19 Ave, Ft Lauderdale, Florida |
Authorized Official Name and Position | John R Clarke (PRESIDENT BROWARD COUNTY DENTAL SUR) |
Authorized Official Contact | 9545629610 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Broward County Dental Surgery Pa Po Box 11223 Ft Lauderdale FL 33339 Ph: (954) 562-9610 | Broward County Dental Surgery Pa 5181 Ne 19 Ave Ft Lauderdale FL 33308 Ph: (954) 562-9610 |
NPI Number | 1861748402 |
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Provider Enumeration Date | 08/01/2012 |
Last Update Date | 12/17/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1861748402 | NPI | - | NPPES |
070653100 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223S0112X | Dentist - Oral And Maxillofacial Surgery | DN5272 (Florida) | Primary |
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