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General NPI Number Information
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NPI Number | 1083082713
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR JAW SURGERY
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Dates
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Enumeration Date | 09/11/2015
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Last Update Date | 04/04/2016
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Provider Practice Location Address
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Address Line | 4420 SHERIDAN ST STE B
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3552
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Country | US
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Telephone | 954-981-4896
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Fax |
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Provider Business Mailing Address
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Address Line | 4420 SHERIDAN ST STE B
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3552
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Country | US
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Telephone | 954-981-4896
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. IRA E STONE
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Credential |
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Telephone | 954-981-4896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 12214
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License Number State | FL
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