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NPI Code Detail

MEDICARE: NOVA SOUTHEASTERN UNIVERSITY, INC

MEDICARE: NOVA SOUTHEASTERN UNIVERSITY, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1669763462
Entity Type Code : Organization
Provider Name (Legal Business Name) : NOVA SOUTHEASTERN UNIVERSITY, INC
Provider Business Mailing Address
First Line : 3200 S. UNIVERSITY DRIVE
Second Line : SANFORD L. ZIFF BLDG. 3RD FLOOR ROOM 4364-D
City : FT. LAUDERDALE
State : FL
Zip : 33328-2018
Country : US
Telephone Number : 954-262-4343
Fax Number : 954-262-2269
Provider Business Practice Location Address
First Line : 3075 NW 35TH AVE
Second Line :
City : LAUDERDALE LAKES
State : FL
Zip : 33311-1107
Country : US
Telephone Number : 954-739-6233
Fax Number : 954-733-9579
Authorized Official
Title or Position : CEO CLINICAL OPERATIONS
Name : ROBER S OLLER
Credential : D.O.
Telephone Number : 954-262-4343
Provider Enumeration Date : 04/27/2011
Last Update Date : 06/17/2011

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Directions to “NOVA SOUTHEASTERN UNIVERSITY, INC ” Practice Location

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