MEDICARE: MIAMI ORAL FACIAL SURGERY PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN17503	FL

General Provider Information

NPI Number	:	1235444191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIAMI ORAL FACIAL SURGERY PA

Provider Business Mailing Address
First Line	:	1155 BRICKELL BAY DR APT 1103
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-2998
Country	:	US
Telephone Number	:	305-804-9074
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 BRICKELL BAY DR APT 1103
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-2998
Country	:	US
Telephone Number	:	305-804-9074
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TERESA LOZANO
Credential	:
Telephone Number	:	305-804-9074

Provider Enumeration Date	:	08/16/2010
Last Update Date	:	08/16/2010

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