| Florida Center For Oral & Maxillofacial Surgery | |
|
17901 Nw 5th St Suite #101 Pembroke Pines FL 33029 | |
| (954) 437-2222 | |
| (954) 437-2244 |
| Full Name | Florida Center For Oral & Maxillofacial Surgery |
|---|---|
| Speciality | Dentist |
| Location | 17901 Nw 5th St Suite #101, Pembroke Pines, Florida |
| Authorized Official Name and Position | Loredana Fontana (OFFICE MANAGER) |
| Authorized Official Contact | 9544372222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Florida Center For Oral & Maxillofacial Surgery 17901 Nw 5th St Suite #101 Pembroke Pines FL 33029 Ph: (954) 437-2222 | Florida Center For Oral & Maxillofacial Surgery 17901 Nw 5th St Suite #101 Pembroke Pines FL 33029 Ph: (954) 437-2222 |
| NPI Number | 1114291036 |
|---|---|
| Provider Enumeration Date | 02/24/2012 |
| Last Update Date | 10/29/2020 |
| Medicare PECOS PAC ID | 8729244348 |
|---|---|
| Medicare Enrollment ID | O20120726000527 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114291036 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DN-16858 (Florida) | Primary |
| Provider Name | Alfredo Tendler |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1487603635 PECOS PAC ID: 1951352855 Enrollment ID: I20050208000981 |
| Provider Name | Michael J Theiss |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1235628991 PECOS PAC ID: 0244587244 Enrollment ID: I20231130000069 |
| Provider Name | Jordan Shapiro |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1225562549 PECOS PAC ID: 6204108210 Enrollment ID: I20240126000495 |
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