Healthcare Provider Details

I. General information

NPI: 1972730695
Provider Name (Legal Business Name): JAMIE SCOTT LURIA D.D.S., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2009
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6171 N FEDERAL HWY
FORT LAUDERDALE FL
33308-2227
US

IV. Provider business mailing address

16385 BISCAYNE BLVD UNIT 2703
AVENTURA FL
33160-5482
US

V. Phone/Fax

Practice location:
  • Phone: 954-641-5610
  • Fax:
Mailing address:
  • Phone: 734-730-8664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN28947
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number019-030536
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: