Healthcare Provider Details

I. General information

NPI: 1932581782
Provider Name (Legal Business Name): FRANCESCO ROBERTO SEBASTIANI D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2015
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date: 04/06/2022
Reactivation Date: 06/06/2022

III. Provider practice location address

6171 N FEDERAL HWY
FORT LAUDERDALE FL
33308-2227
US

IV. Provider business mailing address

4870 DEER LAKE DR E STE 1316
JACKSONVILLE FL
32246-6305
US

V. Phone/Fax

Practice location:
  • Phone: 724-331-6327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number25010
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: