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General NPI Number Information
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NPI Number | 1417618463
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Entity Type | Organization
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Legal Business Name | TREASURE COAST ORAL & MAXILLOFACIAL SURG & DENTAL IMPLANT SURG INC
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Dates
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Enumeration Date | 01/03/2022
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 1265 SE PORT ST LUCIE BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-5376
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Country | US
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Telephone | 772-337-4798
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Fax | 772-337-2004
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Provider Business Mailing Address
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Address Line | 1265 SE PORT ST LUCIE BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-5376
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Country | US
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Telephone | 772-337-4798
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Fax | 772-337-2004
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | STEPHANIE KAUFFMAN
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Credential |
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Telephone | 772-337-4798
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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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