=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164964508
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONTEMPORARY ORTHODONTICS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2016
-----------------------------------------------------
Last Update Date | 08/02/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2751 EXECUTIVE PARK DR SUITE 101
-----------------------------------------------------
City | WESTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33331-3660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-217-3737
-----------------------------------------------------
Fax | 954-217-3738
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2751 EXECUTIVE PARK DR SUITE 101
-----------------------------------------------------
City | WESTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33331-3660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-217-3737
-----------------------------------------------------
Fax | 954-217-3738
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORTHODONTIST
-----------------------------------------------------
Name | DR. MARIA EUGENIA YAZJI
-----------------------------------------------------
Credential | MS, DDS
-----------------------------------------------------
Telephone | 954-217-3737
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number | 14139
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------