| Functional Facial Orthopedics | |
|
13421 S Shore Blvd Suite 203 Wellington FL 33414-7210 | |
| (561) 215-1603 | |
| (561) 537-5738 |
| Full Name | Functional Facial Orthopedics |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 13421 S Shore Blvd, Wellington, Florida |
| Authorized Official Name and Position | Nilsa H Toledo (PRESIDENT/OWNER) |
| Authorized Official Contact | 5612151603 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Functional Facial Orthopedics 13421 S Shore Blvd Suite 203 Wellington FL 33414-7210 Ph: (561) 215-1603 | Functional Facial Orthopedics 13421 S Shore Blvd Suite 203 Wellington FL 33414-7210 Ph: (561) 215-1603 |
| NPI Number | 1407207194 |
|---|---|
| Provider Enumeration Date | 06/24/2016 |
| Last Update Date | 06/24/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407207194 | NPI | - | NPPES |
| D17401 | Other | FL | MEDICAL LICENSE NUMBER |
| 075862100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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