Healthcare Provider Details

I. General information

NPI: 1730337098
Provider Name (Legal Business Name): ENT ASSOCIATES OF BROWARD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8130 ROYAL PALM BLVD SUITE 205
CORAL SPRINGS FL
33065-5703
US

IV. Provider business mailing address

9311 W SAMPLE RD
CORAL SPRINGS FL
33065-4101
US

V. Phone/Fax

Practice location:
  • Phone: 954-345-9191
  • Fax:
Mailing address:
  • Phone: 954-755-8885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberOS10414
License Number StateFL

VIII. Authorized Official

Name: DR. MELANIE LYNN PENCE
Title or Position: MEMEBER
Credential: DO
Phone: 954-755-8885