Healthcare Provider Details

I. General information

NPI: 1366998080
Provider Name (Legal Business Name): FLORIN NICOLAE CICORTAS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 LAKERIDGE BLVD STE 9
BOCA RATON FL
33496-2147
US

IV. Provider business mailing address

5701 SW 24TH AVE
FORT LAUDERDALE FL
33312
US

V. Phone/Fax

Practice location:
  • Phone: 561-852-7700
  • Fax:
Mailing address:
  • Phone: 954-830-0425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN22147
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: