Healthcare Provider Details

I. General information

NPI: 1013292879
Provider Name (Legal Business Name): SOUTH FLORIDA ORAL AND FACIAL COSMETIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E COMMERCIAL BLVD
OAKLAND PARK FL
33334-3391
US

IV. Provider business mailing address

701 E COMMERCIAL BLVD
OAKLAND PARK FL
33334-3391
US

V. Phone/Fax

Practice location:
  • Phone: 954-772-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN15239
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN15237
License Number StateFL

VIII. Authorized Official

Name: DR. TODD J SAWISCH
Title or Position: DR/ORAL SURGEON
Credential: DDS
Phone: 954-772-2000