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General NPI Number Information
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NPI Number | 1861877979
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR FACIAL RESTORATION, INCORPORATED
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 07/30/2015
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Provider Practice Location Address
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Address Line | 1951 SW 172ND AVENUE SUITE 205
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City | MIRAMAR
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State | FL
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Zip | 33029-5613
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Country | US
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Telephone | 954-442-5191
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Fax | 786-228-2853
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Provider Business Mailing Address
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Address Line | 1951 SW 172ND AVENUE SUITE 205
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City | MIRAMAR
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State | FL
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Zip | 33029-5613
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Country | US
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Telephone | 954-442-5191
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Fax | 786-228-2853
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD E DAVIS
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Credential | MD, FACS
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Telephone | 954-442-5191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | ME64358
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License Number State | FL
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