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General NPI Number Information
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NPI Number | 1336436096
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Entity Type | Organization
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Legal Business Name | BOCA JAW SURGERY, PA
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Dates
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Enumeration Date | 07/01/2011
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Last Update Date | 07/01/2011
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Provider Practice Location Address
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Address Line | 16110 JOG RD SUITE 101
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City | DELRAY BEACH
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State | FL
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Zip | 33446-2350
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Country | US
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Telephone | 561-499-3331
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Fax |
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Provider Business Mailing Address
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Address Line | 16110 JOG RD SUITE 101
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City | DELRAY BEACH
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State | FL
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Zip | 33446-2350
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Country | US
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Telephone | 561-499-3331
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Fax |
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Authorized Official
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Title or Position | ORAL AND MAXILLOFACIAL SURGEON
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Name | DR. RONALD L KATZ
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Credential | DMD
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Telephone | 561-499-3331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | DN15190
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License Number State | FL
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