Healthcare Provider Details

I. General information

NPI: 1801139118
Provider Name (Legal Business Name): FACIAL ORTHOPEDICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 SANSBURYS WAY SUITE 201
WEST PALM BEACH FL
33411-3619
US

IV. Provider business mailing address

951 SANSBURYS WAY SUITE 201
WEST PALM BEACH FL
33411-3619
US

V. Phone/Fax

Practice location:
  • Phone: 561-215-1603
  • Fax:
Mailing address:
  • Phone: 561-215-1603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN17401
License Number StateFL

VIII. Authorized Official

Name: DR. NILSA H TOLEDO
Title or Position: DENTAL DIRECTOR
Credential: D.M.D, FAAPD
Phone: 561-215-1603