Provider Demographics
NPI:1285869933
Name:BOCA RATON CENTER FOR ORAL FACIAL & IMPLANT SURGERY, LLC
Entity type:Organization
Organization Name:BOCA RATON CENTER FOR ORAL FACIAL & IMPLANT SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PICCONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-826-2002
Mailing Address - Street 1:2499 GLADES RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7202
Mailing Address - Country:US
Mailing Address - Phone:561-826-2002
Mailing Address - Fax:561-826-2003
Practice Address - Street 1:2499 GLADES RD
Practice Address - Street 2:SUITE 309
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7202
Practice Address - Country:US
Practice Address - Phone:561-826-2002
Practice Address - Fax:561-826-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN161341223S0112X
FLDN173061223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty