Healthcare Provider Details

I. General information

NPI: 1417148495
Provider Name (Legal Business Name): JAY SINGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5481 N UNIVERSITY DR #101
CORAL SPRINGS FL
33067-4643
US

IV. Provider business mailing address

5481 N UNIVERSITY DR #101
CORAL SPRINGS FL
33067-4643
US

V. Phone/Fax

Practice location:
  • Phone: 954-757-6453
  • Fax: 954-757-6161
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN 8347
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: