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Organization
DENTAL IMPLANT & FACIAL SURGERY
Active
Organization
DENTAL IMPLANT & FACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHEL MATOUK MD, DDS (OWNER)
(954) 566-0300
Entity
Organization
Contact information
Practice address
2600 EAST COMMERCIAL BLVD, SUITE 200, FORT LAUDERDALE, FL 33308
(954) 566-0300
(954) 566-9066
Mailing address
2600 EAST COMMERCIAL BLVD, SUITE 200, FORT LAUDERDALE, FL 33308
(954) 566-0300
(954) 566-9066
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
NULL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
Other
Enumeration date
02/11/2022
Last updated
02/11/2022
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