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General NPI Number Information
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NPI Number | 1578078630
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Entity Type | Organization
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Legal Business Name | TLC DENTAL - ORAL SURGERY, PLLC
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Dates
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Enumeration Date | 12/11/2017
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Last Update Date | 12/11/2017
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Provider Practice Location Address
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Address Line | 3001 E COMMERCIAL BLVD
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-4311
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Country | US
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Telephone | 954-491-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 W CYPRESS CREEK RD STE 300
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-1950
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Country | US
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Telephone | 954-720-5511
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING DEPT.
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Name | LAURI STEIN
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Credential |
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Telephone | 954-994-0892
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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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