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General NPI Number Information
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NPI Number | 1164844528
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Entity Type | Organization
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Legal Business Name | CHASE DENTAL SLEEPCARE OF HOLLYWOOD INC.
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Dates
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Enumeration Date | 01/20/2014
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Last Update Date | 03/17/2014
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Provider Practice Location Address
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Address Line | 2525 EMBASSY DR #1
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City | HOLLYWOOD
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State | FL
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Zip | 33026-4573
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Country | US
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Telephone | 954-430-3444
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Fax | 954-430-5688
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Provider Business Mailing Address
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Address Line | 2525 EMBASSY DR #1
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City | HOLLYWOOD
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State | FL
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Zip | 33026-4573
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Country | US
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Telephone | 954-430-3444
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Fax | 954-430-5688
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAURICIO MALO
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Credential | DDS
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Telephone | 954-430-3444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | DN17046
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License Number State | FL
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