# FUNCTIONAL FACIAL ORTHOPEDICS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407207194
- **Authorized official:** DR. NILSA H TOLEDO D.M.D. (PRESIDENT/OWNER)
- **Authorized official phone:** (561) 215-1603

## Contact information

- **Practice address:** 13421 S SHORE BLVD, SUITE 203, WELLINGTON, FL 33414-7210
- **Practice address phone:** (561) 215-1603
- **Practice address fax:** (561) 537-5738
- **Mailing address:** 13421 S SHORE BLVD, SUITE 203, WELLINGTON, FL 33414-7210
- **Mailing address phone:** (561) 215-1603
- **Mailing address fax:** (561) 537-5738

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 06/24/2016
- **Last updated:** 06/24/2016