Healthcare Provider Details

I. General information

NPI: 1679410625
Provider Name (Legal Business Name): NOVA SOUHTEASTERN UNIVERSITY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 S. UNIVERSITY DR 2ND FLOOR
FORT LAUDERDALE FL
33328
US

IV. Provider business mailing address

PO BOX 290370
DAVIE FL
33329-0370
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-4100
  • Fax:
Mailing address:
  • Phone: 954-262-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JOHN XANTHOS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 954-262-4100