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General NPI Number Information
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NPI Number | 1669964276
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Entity Type | Organization
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Legal Business Name | FORT LAUDERDALE GALLERIA DENTAL IMPLANT AND ORTHODONTIC CENTER
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 2300 NE 9TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-3579
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Country | US
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Telephone | 954-566-1281
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 NE 9TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-3579
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Country | US
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Telephone | 954-566-1281
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DENNIS SEVEL
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Credential | DDS
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Telephone | 954-566-1281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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