Healthcare Provider Details

I. General information

NPI: 1962889204
Provider Name (Legal Business Name): VANGUARD PLASTIC SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10600 GRIFFIN RD STE 107
COOPER CITY FL
33328
US

IV. Provider business mailing address

347 N NEW RIVER DR E APT 2810
FT LAUDERDALE FL
33301-3170
US

V. Phone/Fax

Practice location:
  • Phone: 954-563-4500
  • Fax:
Mailing address:
  • Phone: 954-563-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE DRESZER
Title or Position: MEMBER
Credential: MD
Phone: 954-563-4500