Healthcare Provider Details

I. General information

NPI: 1437660800
Provider Name (Legal Business Name): CORAL SPRINGS FAMILY ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 N UNIVERSITY DR
CORAL SPRINGS FL
33071-8915
US

IV. Provider business mailing address

1406 NW 127TH WAY
CORAL SPRINGS FL
33071-5446
US

V. Phone/Fax

Practice location:
  • Phone: 954-393-0303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN16107
License Number StateFL

VIII. Authorized Official

Name: BLANCA ROJAS
Title or Position: PRESIDENT
Credential:
Phone: 561-235-8315