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General NPI Number Information
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NPI Number | 1336340470
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Entity Type | Organization
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Legal Business Name | ORAL & FACIAL SURGERY CENTER
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 03/21/2008
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Provider Practice Location Address
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Address Line | 4765 S CONGRESS AVE
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City | LAKE WORTH
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State | FL
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Zip | 33461-4700
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Country | US
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Telephone | 561-439-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 4765 S CONGRESS AVE
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City | LAKE WORTH
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State | FL
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Zip | 33461-4700
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Country | US
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Telephone | 561-439-6600
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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. GERARD A. MORETTI
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Credential | DMD,PA
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Telephone | 561-439-6600
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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 | 6230
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License Number State | FL
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