Treasure Coast Oral & Maxillofacial Surg & Dental Implant Surg INC
Dentist, Oral and Maxillofacial Surgery in Port St Lucie, FL. Organization (NPI-2).
NPI number1417618463
StatusActive
Last updated in NPPESJan 3, 2022
Details
- NPI
- 1417618463
- Entity type
- Organization (NPI-2)
- Legal business name
- Treasure Coast Oral & Maxillofacial Surg & Dental Implant Surg INC
- Organization subpart
- No
- Enumeration date
- Jan 3, 2022
- Certification date
- Jan 3, 2022
- Last updated
- Jan 3, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | – | – | Yes |
Practice location
1265 Se Port St Lucie BlvdPort St Lucie, FL 34952-5376
Phone 772-337-4798 · Fax 772-337-2004
Mailing address
1265 Se Port St Lucie BlvdPort St Lucie, FL 34952-5376
Phone 772-337-4798 · Fax 772-337-2004
Authorized official
Stephanie Kauffman
Office Manager
7723374798
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