Healthcare Provider Details

I. General information

NPI: 1992147466
Provider Name (Legal Business Name): JEFFREY MARC EISNER, D.M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11020 N KENDALL DR SUITE 106
MIAMI FL
33176-1246
US

IV. Provider business mailing address

11020 N KENDALL DR SUITE 106
MIAMI FL
33176-1246
US

V. Phone/Fax

Practice location:
  • Phone: 305-279-8600
  • Fax: 305-279-6918
Mailing address:
  • Phone: 305-279-8600
  • Fax: 305-279-6918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY MARC EISNER
Title or Position: OWNER
Credential: D.M.D.
Phone: 305-279-8600