MEDICARE: SEIDER & STEVENS 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	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center

General Provider Information

NPI Number	:	1396834826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEIDER & STEVENS PA

Provider Business Mailing Address
First Line	:	3157 N UNIVERSITY DR
Second Line	:	SUITE 104
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024
Country	:	US
Telephone Number	:	954-431-1600
Fax Number	:	954-432-7994

Provider Business Practice Location Address
First Line	:	2699 STIRLING RD
Second Line	:	SUITE C-203
City	:	HOLLYWOOD
State	:	FL
Zip	:	33312
Country	:	US
Telephone Number	:	954-966-7100
Fax Number	:	954-962-1985

Authorized Official
Title or Position	:	SEC TREAS
Name	:	JEFFREY ALAN STEVENS
Credential	:	DMD
Telephone Number	:	954-966-7100

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/14/2008

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