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General NPI Number Information
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NPI Number | 1184262719
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Entity Type | Organization
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Legal Business Name | AMERICAN ORAL SURGERY INC.
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Dates
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Enumeration Date | 12/13/2019
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Last Update Date | 12/13/2019
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Provider Practice Location Address
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Address Line | 18501 PINES BLVD STE 211
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-1420
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Country | US
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Telephone | 954-417-1330
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Fax | 954-637-1955
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Provider Business Mailing Address
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Address Line | 18501 PINES BLVD STE 211
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-1420
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Country | US
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Telephone | 954-417-1330
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Fax | 954-637-1955
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | WILLIAM PENA
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Credential | DMD
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Telephone | 954-417-1330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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