Healthcare Provider Details

I. General information

NPI: 1033357611
Provider Name (Legal Business Name): NOVA SOUTHEASTERN UNIVERSITY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

IV. Provider business mailing address

3200 S. UNIVERSITY DRIVE SANFORD L. ZIFF BLDG. 3RD FLOOR, ROOM 4364-D
FT. LAUDERDALE FL
33328-2018
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-7500
  • Fax: 954-262-7164
Mailing address:
  • Phone: 954-262-4343
  • Fax: 954-262-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: ROSEMERY ESTEVEZ
Title or Position: DIR CONTRACTING AND CREDEN
Credential:
Phone: 954-262-4343