Healthcare Provider Details

I. General information

NPI: 1124799119
Provider Name (Legal Business Name): SPECIALISTS IN ORTHODONTICS OF FLORIDA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3353 N UNIVERSITY DR
CORAL SPRINGS FL
33065-4162
US

IV. Provider business mailing address

2970 BRANDYWINE RD STE 200
ATLANTA GA
30341-5528
US

V. Phone/Fax

Practice location:
  • Phone: 954-416-0727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MONICAQ PERKINS
Title or Position: ONBOARDING SPECIALIST
Credential:
Phone: 770-692-1000