Healthcare Provider Details

I. General information

NPI: 1912002585
Provider Name (Legal Business Name): FLORIDA ORAL & FACIAL SURGICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 HEALTH BLVD
DAYTONA BEACH FL
32114-1493
US

IV. Provider business mailing address

549 HEALTH BLVD
DAYTONA BEACH FL
32114-1493
US

V. Phone/Fax

Practice location:
  • Phone: 386-252-6438
  • Fax:
Mailing address:
  • Phone: 386-252-6438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JOHN AKERS
Title or Position: OFFICER
Credential:
Phone: 386-252-6438