MEDICARE: SOUTH FLORIDA DENTAL SURGICAL SPECIALISTS 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)	DN 11443	FL

General Provider Information

NPI Number	:	1376890673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA DENTAL SURGICAL SPECIALISTS PA

Provider Business Mailing Address
First Line	:	9600 W SAMPLE RD
Second Line	:	SUITE 504
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4045
Country	:	US
Telephone Number	:	954-340-6550
Fax Number	:

Provider Business Practice Location Address
First Line	:	9600 W SAMPLE RD
Second Line	:	SUITE 504
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4045
Country	:	US
Telephone Number	:	954-340-6550
Fax Number	:	954-340-8488

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFFREY F. ELLIOT
Credential	:	DMD
Telephone Number	:	954-340-6550

Provider Enumeration Date	:	08/06/2012
Last Update Date	:	02/11/2013

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