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General NPI Number Information
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NPI Number | 1407207194
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL FACIAL ORTHOPEDICS
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Dates
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Enumeration Date | 06/24/2016
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Last Update Date | 06/24/2016
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Provider Practice Location Address
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Address Line | 13421 S SHORE BLVD SUITE 203
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City | WELLINGTON
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State | FL
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Zip | 33414-7210
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Country | US
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Telephone | 561-215-1603
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Fax | 561-537-5738
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Provider Business Mailing Address
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Address Line | 13421 S SHORE BLVD SUITE 203
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City | WELLINGTON
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State | FL
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Zip | 33414-7210
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Country | US
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Telephone | 561-215-1603
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Fax | 561-537-5738
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. NILSA H TOLEDO
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Credential | D.M.D.
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Telephone | 561-215-1603
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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 |
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License Number State |
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