MEDICARE: ORAL AND FACIAL SURGERY OF FLORIDA, 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
1	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center	DN15621	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760722474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORAL AND FACIAL SURGERY OF FLORIDA, INC.

Provider Business Mailing Address
First Line	:	801 CHAMPION WOODS CT
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-7164
Country	:	US
Telephone Number	:	407-756-7172
Fax Number	:

Provider Business Practice Location Address
First Line	:	19051 US HIGHWAY 441
Second Line	:	SUITE 104
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-6708
Country	:	US
Telephone Number	:	407-756-7172
Fax Number	:

Authorized Official
Title or Position	:	OWNER/SURGEON
Name	:	DR. ABDUL MAJID AZIZI
Credential	:	D.M.D.
Telephone Number	:	407-756-7172

Provider Enumeration Date	:	02/18/2013
Last Update Date	:	02/18/2013

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