# DENTAL IMPLANT & FACIAL SURGERY

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

## Provider details

- **NPI number:** 1528712189
- **Authorized official:** DR. MICHEL MATOUK MD, DDS (OWNER)
- **Authorized official phone:** (954) 566-0300

## Contact information

- **Practice address:** 2600 EAST COMMERCIAL BLVD, SUITE 200, FORT LAUDERDALE, FL 33308
- **Practice address phone:** (954) 566-0300
- **Practice address fax:** (954) 566-9066
- **Mailing address:** 2600 EAST COMMERCIAL BLVD, SUITE 200, FORT LAUDERDALE, FL 33308
- **Mailing address phone:** (954) 566-0300
- **Mailing address fax:** (954) 566-9066

## Taxonomy

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