Healthcare Provider Details

I. General information

NPI: 1811409832
Provider Name (Legal Business Name): GONZALO JOSE SADER VERDE DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 NW 33RD ST STE 107
CORAL SPRINGS FL
33065-4000
US

IV. Provider business mailing address

9750 NW 33RD ST STE 107
CORAL SPRINGS FL
33065-4000
US

V. Phone/Fax

Practice location:
  • Phone: 954-539-9400
  • Fax: 954-539-9444
Mailing address:
  • Phone: 954-539-9400
  • Fax: 954-539-9444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number18256
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN30849
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number34884
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: