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General NPI Number Information
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NPI Number | 1548410947
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Entity Type | Organization
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Legal Business Name | NOVA SOUTHEASTERN UNIVERSITY, INC
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 06/24/2011
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Provider Practice Location Address
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Address Line | 830 E OAKLAND PARK BLVD
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City | OAKLAND PARK
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State | FL
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Zip | 33334-2761
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Country | US
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Telephone | 954-262-7530
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Fax | 954-568-7749
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Provider Business Mailing Address
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Address Line | 3200 S UNIVERSITY DR SANFORD L. ZIFF BLDG. 3RD FLOOR ROOM 4364-D
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City | FT. LAUDERDALE
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State | FL
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Zip | 33328-2018
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Country | US
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Telephone | 954-262-4343
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Fax | 954-262-2269
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Authorized Official
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Title or Position | CEO CLINICAL OPERATIONS
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Name | ROBERT S OLLER
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Credential | D.O.
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Telephone | 954-262-4343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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