| Las Olas Centre For Oral & Maxillofacial Surgery | |
|
100 Se 15th Ave Ft Lauderdale FL 33301-3985 | |
| (954) 983-1899 | |
| (954) 986-6846 |
| Full Name | Las Olas Centre For Oral & Maxillofacial Surgery |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 100 Se 15th Ave, Ft Lauderdale, Florida |
| Authorized Official Name and Position | Jason E Portnof (OWNER) |
| Authorized Official Contact | 9549831899 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Las Olas Centre For Oral & Maxillofacial Surgery 100 Se 15th Ave Ft Lauderdale FL 33301-3985 Ph: (954) 983-1899 | Las Olas Centre For Oral & Maxillofacial Surgery 100 Se 15th Ave Ft Lauderdale FL 33301-3985 Ph: (954) 983-1899 |
| NPI Number | 1699190280 |
|---|---|
| Provider Enumeration Date | 02/19/2014 |
| Last Update Date | 01/25/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699190280 | NPI | - | NPPES |
| HA085Z | Other | FL | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DN16048 (Florida) | Primary |
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